Seattle Council Finance & Neighborhoods Committee Lunch & Learn: The Affordability of Long-Term Care

Good afternoon, everyone.

This is Wednesday, September 4th.

We have a special meeting of our Finance and Neighborhoods Committee.

I'm Sally Bagshaw, chair of this committee, and I am delighted that today what we're doing is having a lunch and learn with some of my favorite people.

that are working on all ages and abilities and how we can care for our seniors and people who have special needs.

So today, I think we're going to be talking about the Long-Term Care Trust Act.

And I think I'm just going to turn it over.

If you want to start, Kathy, with introductions, go around the table.

Irene, did you want to join us up here at the table?

Anybody else?

OK.

Very good.

OK.

Thank you.

Thank you so much for hosting this event today for this important topic.

I'm Kathy Knight.

I'm with the Aging and Disability Services Division of the Seattle Human Services Department.

Great.

Thanks, Kathy.

I'm G. DiCastro.

Thank you for having us here.

I serve as the Director of Aging and Adult Services at Asian Counseling and Referral Service, ACRS.

Great.

Thank you, Jean.

And I'm Kathy McCall.

I'm the advocacy director for AARP here in Washington state.

And in the state, we have a little under a million members.

Thank you, Kathy.

Thank you all for being here.

All right, Kathy Knight, do you want to start off and tell us why this is important and why Long-term care is something we should be paying attention to.

I'm happy to do that.

Yes, we're going to talk about affordability of long-term care.

It's an expense that most families encounter, but few are prepared for.

So let's start off right off the bat with what is long-term care.

And I will use the term long-term care and long-term services and supports interchangeably.

And because that's a mouthful, a lot of times you'll hear people say LTSS.

You'll see those abbreviations.

The disability community prefers long-term services and supports.

They find the term care a little pejorative.

We're referring to a variety of services that are designed to meet an adult's health or personal care needs so they can continue to live as independently and safely as possible.

So there's some examples here of the kind of services that are considered part of the long-term care system.

And who needs long-term care?

Well, probably over half of the individuals turning 65 will need some type of long-term services and supports in their lifetime.

Those statistics are even higher as people get older.

We expect that a good 14% will need those services for five years or more.

And you can see the dollar amount.

It is not cheap, 15% in excess of $266,000 during their lifetime.

If you're over age 85, there's a good chance one in three of us will have some type of cognitive impairment.

Could be Alzheimer's, another type of dementia.

And the estimated lifetime cost of care for dementia is even higher.

You can see that's more around $341,840.

That's pretty exact, isn't it?

There's an example of some of the average costs of care at this time.

And you can see it goes from lower cost services for people who are able to stay in the community and use services like an adult daycare program during the day, up through assisted living and nursing home.

And that's what we're, when we talk about affordability, we have to look at the costs of those different settings and services.

So what we're going to do today is we're going to talk about long term services and supports, what services are available, how they're funded, some of the challenges and opportunities, and we want to make sure everybody leaves here today knowing where you can go for help.

I'm here on behalf of Audrey Buehring.

She sends her apologies.

She really hoped to be here today to introduce this important topic.

You can see the other presenters.

I'm really thrilled to have Kathy here with me today and Gee.

They're both partners in this work and they'll be able to talk about some of the perspectives they have on the issues.

But I'm going to start off by talking a little bit about aging and disability services, sort of set the framework for what we're talking about in the continuum of care and the long-term support system.

And aging and disability services, as a division of the city of Seattle, also plays another important role.

It's the area agency on aging for Seattle and King County.

We've been doing this for over 40 years.

Really proud of the work that we've been able to do for the city and the county to make lives better for older adults and for people with disabilities.

This slide is not the easiest to read, but it does show you how the national network was established and its connection with local area agencies.

I mean, if you go back to 1965, remember those good old days, 1965?

A lot happened.

We had a very progressive Congress.

We had Medicare for older adults who needed health insurance, Medicaid for low income individuals, passed the Voting Rights Act.

We also had the Older Americans Act.

That was the beginning of the recognition that many older adults needed some kind of extra support to maintain their independence in the community.

So that established the Administration on Aging and State Units on Aging.

And by 1973, we had the Area Agencies on Aging.

And that's when the local focus came in.

That was when the recognition was that it's at the local level that we know what the greatest needs are.

And we need to tailor the services to the needs of the community.

So we've been proud to be doing that work.

I have a great team of people working on behalf of the city and the county.

So I will have to say, if you can go back to that slide, it is hard to see.

The one that I have in my book, the font is about 0.1.

I can't read it there either.

So what would you say has improved between the left and the right?

What has improved?

Well, it's sort of a progression, and it's just a relationship.

I mean, we have a very clear relationship to the state and to the federal government in terms of our responsibilities in serving older adults.

And the initial framework for the national network was just a recognition that resources needed to be allocated, but it was not And it was grants directly to states.

I think a big improvement was the area agencies on aging and that local focus, that ability.

What we need in King County is different than what people might need in Spokane County.

And we have the ability to adapt our services to meet those needs.

So in terms of the services we provide, we have a budget of $48 million.

That includes our Federal Older American Act dollars.

We're also, we have a large Medicaid contract to provide case management services for individuals who qualify for Medicaid long-term supports and want to stay at home.

They're not in a residential setting or a nursing home.

So it's very important to us in terms of helping those folks try to stay safe and live as healthy as possible in the community.

We have state funds.

We have Senior Citizen Services Act.

We have family caregiver support, some great flexible dollars that help supplement our work.

And then, of course, we have local.

funds, and city dollars, which we're very appreciative of having.

So what do you think in terms of the numbers of people who are served as contrasted to people who want to stay in their home?

Do we have enough resources to keep everybody at home with what they need, or are we lacking?

And if so, how do we bridge that gap?

Well, we don't have a waiting list right now.

So if a person applies and qualifies for Medicaid and they qualify for long-term services and support, so they functionally meet the definition, they have a choice and they can.

not in every state, but in this state, they have a choice of living at home and the support's being brought to them.

So that's an entitlement program.

So we serve whoever comes through the door who meets those eligibility requirements.

And one of the points I wanted to make is area agencies, we've adapted over the years.

We're now serving folks who are close to homelessness, may be homeless, we're actually looking at our needs expanding to serve the needs of this particular community, but we do not have a waiting list for the Medicaid program.

Okay, thank you.

Yes, we do our services through over 150 contracts with 75 community agencies, one of which is GEES, and we're very proud to have that partnership.

He is one of our case management contractors, so we have both folks at the city who provide those services, as well as contracted providers in the community.

Total programs overall between our Older American Act dollars and all our funds, we serve over 46,000 people in 2018 in King County.

It's important to remember we do provide services throughout King County.

And I mentioned the case management program, our Title 19 Medicaid program.

We're serving about 15,000 people and keeping those folks safe at home for as long as possible.

I want to step back for a minute because I think it's important to think of long-term supports in a broad continuum and starting at the point of if we think about where health happens and look at really, you know, we all now know the whole, the formal healthcare system is about 20% of it.

And so much happens in terms of our own behaviors, the responsibility we take in our lifestyle choices and our habits, socioeconomic factors are a major factor, as well as the physical environment.

So it's those 80%, those social determinants of health that have a great deal to do with how somebody does as they age.

And we know your zip code, we already know your zip code does play a factor in that.

And also things like you said, healthy behaviors up there.

We have choices on how much alcohol we use, how many cigarettes we smoke, and whether or not we are exercising.

The diet's an issue when you're coming back to the zip codes and whether people have healthy foods available in their neighborhood.

And so we want to, part of our work is to stay really aware of that in terms of serving the needs in King County.

So just in terms of what you're saying, we want everybody to be aging as healthy as possible.

And so some of our core services that we provide through Aging and Disability Services, through our Older American Act dollars, we have, and also thank you so much for being such a champion for age-friendly communities because now that Seattle's an age-friendly community, we're doing a number of activities that are really promoting engagement and involvement for people.

And that's so important for healthy aging.

That isolation is so detrimental to a person's health.

We encourage people to take responsibility.

If you have a chronic disease, we have programs that help people manage that.

Falls prevention, we know a fall can make a big difference in the quality of a person's life.

It is what often puts a person in a long-term care setting, possibly indefinitely.

Nutrition, absolutely critical.

It's one of the core services under the Older American Act dollars and we invest lots in nutrition into many ethnic communities to try to really promote positive health there.

Oral health, we're learning so much more about the impact of oral health.

It's now being tied to dementia and Alzheimer's.

So it's important.

And then, you know, Medicare doesn't cover dental.

So that's something that people often struggle with when they are retired and they don't have access to dental insurance any longer.

So is there anything in the state that can people access an insurance pool for dental care?

You know, Kathy might know that better than I do.

Right now there really isn't, but there has been work done in the legislature to look at how dental can be included under Medicaid.

But that requires us to get a federal change, not just a state law change, correct?

We can do it at the state level, too.

Oh, great.

So if you could just put a bookmark in this.

Let's talk to our Office of Intergovernment Relations this fall.

Let them know how important this is.

Because I didn't know there was a direct connection to dementia, but I have heard over and over again If your dental health is poor, your overall physical health is going to be worsened.

And so it strikes me that if we can do something with the legislature to really help improve or allow people to have access to affordable dental insurance, it will be really an important step.

Absolutely.

You know, we're right in the middle or almost finishing our four-year area plan.

It's one of the things we're mandated to do as an area agency on aging and oral health is identified in that plan.

We might be able to find some specific strategies that we would want to be addressing in that area in the next four years.

Good.

I would very much like to see if we could move that forward.

Great.

So in terms of healthy aging, it's just great to think about all the resources we have in Seattle and King County.

We have a great partnership with Seattle Parks and the Lifelong Recreation Program.

There's dementia friendly activities.

We have Momentia Seattle.

There's many many things going on to really promote opportunities for people to be active, to be engaged, to try to stay as healthy as you can.

And we also have a place where folks can go when they need information about these kind of resources or any other.

And we have what we call our Community Living Connections Network.

One of the core services under the Older Americans Act, when it was originally established, was called Senior Information Assistance, Senior INA.

So that has evolved over the years to meet the needs.

And it's expanded its role, focused on not only older adults, but adults with disabilities.

caregivers, sort of anyone who's dealing with challenges related to the long-term care system or just planning ahead for meeting those needs.

So people, you can get a free consultation.

It's individual.

There's whatever support and assistance you need in terms of accessing services.

It's professional and confidential.

There's no wrong door.

And we've- Where do people go for free consultation?

Well- Odd that I should ask.

There's a little map.

Thank you.

We right now have 22 agencies in the network.

We just finished a collaborative funding process and working with those community partners so that we can, we're working to try to make as seamless a network as possible in King County.

So folks can either call that central number.

If they're familiar with a local agency that's part of the network, they may go to them because they feel more comfortable reaching out to somebody that might speak their language or represent their community.

We've really tried to reflect the diversity of the county in terms of expanding our community living connections network.

And there's a focus on collaboration for equity and a real person-centered approach to meeting the individual's needs.

So let me ask you a question about collaborating with the county.

So last year they had, or two years ago now, I had a very effective levy, countywide success for their veterans and human services and seniors they added.

So is there coordination among programs and funding coming from the county for those?

Absolutely.

My staff have been working with the county staff to really coordinate our efforts because we do have connections in the services we provide.

We want to make sure that we're not duplicating, we're coordinating, filling gaps where we For instance, in our Community Living Connections Network, the need was greater than the resources available.

We couldn't fund everything, but we're working with county staff who do have some dollars for similar services, and we're hoping that in cooperation with them, we'll be able to fill some of those gaps.

And that goes for some of the other services that are being provided through the Veterans, Seniors, and Human Services Levy.

So there's, so, you know, when you go to this no wrong door or call the number, you can access all kinds of services.

You know, we talk about area agencies as the AAAs.

I say we're not the AAA you call when you need your tire changed, but we might be the AAA you call if you need transportation to a meal site or need to know who can send meals to your mom.

So we think of ourselves as access to a broad range of services and supports and resources for people.

So that's the, so we're sort of going through the continuum and now we're moving to the level where we're, there comes a time where some folks do need extra support, they just do.

And we've sort of had a very predictable path to the Medicaid long-term services and support system in this state and that is you have need for help, need care.

You have family members who help as long as they can.

They're becoming exhausted.

You're exhausting your resources.

And that's that whole spend down.

And then you need to turn to the formal Medicaid system to get your services.

And those are many of the folks that we're serving now that I had mentioned earlier through our case management program.

Because you can see, compared to the average lifetime savings for retirement versus the cost, There's a definite gap.

But Kathy's going to talk about one of the opportunities we have to try to address that.

Thank you.

So I just want to go back to looking at the continuum and as we look at the level where folks need more support.

And I've already talked a lot about our case management program.

I could talk for hours about the important work that the case managers do.

They really make a difference in people's lives and deal with all kinds of issues and helping folks just to stay at home and get the support they need.

We also have a very robust caregiver support system in this state.

Once again, Washington led the way.

Not only do we lead the way with our home and community support system, but we also have done a lot since the late 80s to serve caregivers.

And now we're part of a Medicaid transformation waiver, really excited to be part of an effort to expand services to caregivers and actually be able to access Medicaid dollars to do that, which allows us to provide more services to more people.

And because of all that, We're so proud that we're number one.

And that's, again, I think that's because we had visionary leadership in the mid-90s when we deliberately rebalanced our system.

We went from 85% of the Medicaid budget going to nursing homes to now over 50% of the budget going to home and community services, allowing people more choices.

And sort of flip now, 85% of the people in the system are served in the community versus nursing home.

So we're really proud that we have achieved a number one ranking, particularly because we're such a cost effective system for many of the choices that have been made.

And now again, with our family caregiver and our Medicaid transformation, we feel like we're leading the way again in the nation and showing other folks how to support families.

And so in that last sentence where you said supporting families, is that what we're being graded on there?

Consistently leading the pack?

Well, we were second for a long time to Minnesota.

But that's because Minnesota had a much more costly system.

So we always thought for being as cost effective as we were, we were number two.

But we became number one in 2017. So we're very proud of that.

I'm sorry, Kathy.

Maybe my question wasn't clear.

What are we graded on?

When we're the number one system.

What are they saying?

Lots of criteria.

And Kathy, I should just turn this over to Kathy because she, there's a lot, I don't even know how many different criteria for ranking us on that.

All right, good.

Well, we'll turn it over to you.

There's probably about 17 to 20 to 30. I can't remember the criteria.

What are the top three, as an example?

Family caregivers, support for family caregivers.

No choice was a big one.

In choice, the choice program.

The ability to access Medicaid.

The demonstration waiver, our Medicaid expansion in the state.

The number of readmissions out of nursing homes and long-term care facilities.

Again, a variety of issues were all factored into that scorecard.

And AARP and the SCAN Foundation worked on the development of the scorecard.

We do it every two years.

And one of my priorities working for AARP is to make sure that we maintain that number one status and really looking at creative, innovative ways that we can address long-term care and support our family caregivers.

And so when it comes to family caregivers, for AARP, family caregivers are the backbone of the long-term care system.

And I think you started to ask that a little bit.

And we know that about 80% of care is provided by friends and family.

And they really do the heroic work without pay in most cases.

And they lose benefits.

They lose the ability to save for their own retirement and for their own long-term care needs.

They also are, again, pulling money out of their own pockets.

And on average are spending about 25% of their income.

So, again, that's from an economic challenge that is something that is equally burdensome for families.

So, not only the care, but the financial cost.

So, when it comes to additional challenges, Kathy had mentioned that, you know, on average people have saved about $148,000 for retirement.

And if you think about that for savings for retirement and the actual cost of $266,000, the gap is pretty apparent when it comes to people's ability to fund their retirement and also fund long-term care.

One of the things that really strikes me is we've done a lot of data and a lot of polling, and it's quite interesting.

A majority of people do not think they're going to ever age.

They will not be old.

We're all invincible.

And when we age, that we're never going to get sick.

We're never going to need surgery.

We're never going to need care and assistance.

And it's that denial that is the concerning part for us when it comes to thinking about long-term care and looking for those really innovative approaches, which I'm going to talk about more.

So again, we know we have about 800,000 caregivers in this state.

We have a woman who's sitting in the audience, Ruth Edgar, who is a fantastic caregiver and worked with us down in the state legislature on developing the Long-Term Care Trust Act.

And I'll go into more details on that.

The other real challenge, so in addition to people thinking they're not gonna age, they're not gonna need any kind of care, everyone thinks that Medicare pays for long-term care.

It does not.

Medicare does not pay for long-term care.

There's a very small number of days that Medicare will pay after you get out of a hospital for a surgery or another emergency procedure as rehabilitative care, but it will not take care of long-term care.

And so people are under the misperception and that is also something that's creating a real challenge because factor in all of those things and then layer on the fact that people do not have long-term care insurance.

The long-term care insurance market is broken.

We had about 30 providers about 20 years ago that were providing long-term care insurance products, and now that's down to maybe seven providers in the state.

Long-term care insurance is prohibitively expensive for a lot of families to pay the premiums.

And oftentimes they invest in the product early on in their 40s and 50s, as they should, but the premiums go up and they often have to walk away from the benefits of the long-term care insurance market.

So if you factor in all of those issues, people don't think they're going to get old.

They're not going to need care.

We have a broken insurance market.

People are under the false assumption that Medicare will pay for it.

That's really led and built the framework for what we wanted to do in this state in developing the Long-Term Care Trust Act.

It's a big, bold, ambitious solution to address the challenges that family caregivers face.

The Long-Term Care Trust Act basically creates a $36,500 lifetime benefit.

And it can be used for a variety of care options.

It's going to be collected through a .58% premium on wages.

So that's roughly about $290 for somebody that's making $50,000 annually.

You have to be a resident of the state.

You have to be 18 years old or older.

The payment for the benefit starts in 2022. The first benefits will be paid out in 2025. And you have to also have three activities of daily living as your challenges for accessing this benefit.

Washington State was the first in the nation to actually enact this type of big, bold, very exciting, really revolutionary in a lot of ways, solution.

And we're excited.

AARP was really excited to support along with our partners, SEIU, the Alzheimer's Association, LeadingAge.

We had about 36 coalition partners and we had no organized opposition because there was real recognition that this is a complex issue and everybody ages, Republicans and Democrats.

And so it was a bipartisan bill when it made it to the floor.

Some partisan politics did step in, but at the end of the day, people recognized that, yes, as Kathy Knight explained, we do have, you know, we don't have a waiting list for Medicaid right now.

But with the population aging and within the next 30 years, you're going to have three times the number of people 85 and older.

That is also the challenge that the state needs to face.

And we need to build a solution now and get it in place for a system to be able to fund and support people for their long-term care needs as they age so that they can age with purpose and dignity.

So, Kathy, both of you, but Kathy McCall, since you're on a roll here, so this past in 2019, and you said it was a bipartisan bill, had the support.

Can everybody who is over 65, and as you said, have three activities of daily living that's impacting, can everybody apply for this, or do you have to begin to pay in?

To whom does it?

Everyone will start paying in who is working in 2022. So if you are employed, you will start paying into this benefit and it will be a benefit that you can access at any point.

So you could be 22 years old and have had a terrible car accident and need to access long-term care.

And so what if somebody who's retired now, the 75-year-old who is still vibrant and takes a look at this and she goes, I want to have access to this too.

Can you buy back in?

We are looking at that option, actually, for 2022 legislation, or 2021 potentially as well.

And because working for AARP, we recognize that there are a lot of people that, you know, the private insurance market failed.

They don't have recourse.

Is there a way potentially for them to buy in?

The challenge is that it might still be pretty prohibitively expensive to make the benefit work.

And also, how does it actuarially work with in the state budget?

So but it's something definitely on our radar in terms of importance and making sure that current seniors have access to care as well.

But it's something we will have to go back to the state legislature for.

Thank you.

So a lot of people say, you know, what is it that the Trust Act will pay for?

And a $36,500 benefit doesn't seem like very much money.

But that's when you consider and you only think about care as in a facility, in a nursing home or assisted living facility.

But again, from AARP's perspective, we want to make sure that people are staying in their homes and have the ability to age in place.

And so that means the $36,500 benefit, people could have 25 hours a week of in-home care.

They could have nine to 18 months of residential care in an adult family home, or five to six months care in a nursing home.

Or they could use their benefit to pay their family member to help care for them.

and or pay for respite care for that family caregiver so that they can go on with their life.

But again, the goal and why AARP supported this and really pushed hard to make sure family caregivers were involved and could benefit from this.

was we wanted to make sure that families were not put at further jeopardy or risk because of the long term care crisis and the need to find family caregivers and supportive a supportive network of care providers.

And so what's great is the long term care benefit can be used for those variety of services that support a family caregiver from respite care to actually paying a family caregiver to care for you.

Great.

Do you want to talk about the The other work that we're doing, and AARP has been involved with also a broad array of organizations, is the Dementia Action Collaborative.

And this was led by the Alzheimer's Association.

And the real challenge is, again, as we have an aging population, and Alzheimer's and other form of dementia are becoming more prominent and becoming such a burden on a lot of family members when it comes to providing care, that there was the Alzheimer's state plan that was created and then there was the Dementia Action Collaborative that was the collaboration of about 30 organizations to actually look at how we implement the plan.

And AARP was part of that dementia action collaborative and looking at how do you raise public awareness?

How do you really remove some of the stigma associated with Alzheimer's and dementia?

How do you educate younger people how to interact with people and not pass judgment?

or how to, you know, interact with their grandparent who might have that disease.

Really good questions.

Do you have answers?

We do.

So we've been working with some really great organizations called Dementia Friends, for example.

We've been working with the libraries.

We've been doing art exhibits, there's memory cafes in communities now where people can go and it's a safe place for either people experiencing Alzheimer's or dementia or their family members can go talk and share and interact and build a network of support within their communities.

And then we also have a whole entire track that's looking at the medical community and public health providers and making sure that they have information, making sure that our medical professionals, if they have to give a diagnosis to somebody that they have Alzheimer's or dementia, that they also have the resources to give to them, to point them to resources in their community for support.

So there is, I want to say the book is about three inches thick of all the tactics and work that needs to be done.

And it's all right now being done very much voluntary, but the state legislature also, really, really made a huge decision and put, I believe it was about $5 million into the Alzheimer's state plan and implementation in the state.

Do you know who was taking the lead in the legislature on that?

Under the Joint Legislative Executive Committee on Aging and Disability is where the Dementia Action Collaborative kind of bubbled up from in terms of a recommendation.

So the Alzheimer's Association has been very much the lead.

Senator Kaiser, who's on the Dementia Action Collaborative and on the Joint Legislative Executive Committee for Aging and Disability, Representative Steve Therringer, Representative Laureen Jenkins, who is on the Joint Legislative Executive Committee, and she was also the sponsor of the Long-Term Care Trust Act and is now our new speaker-elect.

And we have Representative Barkas, and I'm missing two others.

Thank you.

Thank you.

Make sure that we get some thank you notes to them.

I think they have their first meeting next week.

They call it JLAC.

I think they meet on next week.

Good.

And do you all go?

Yes.

Do you participate?

We're not on the committee.

We have two organizations that are on the committee, Patricia Hunter representing the state long-term care ombudsman, and David Lord representing Disability Rights Washington.

And then they have staff from DSHS and the governor's office and the office of the insurance commissioner also on that committee.

And that committee was born out of the Governor's Summit on Aging back in 2015, 13. Wow, six years ago.

I wish we got there.

Nice.

Well, if you're attending, I would be very interested on this.

As we were discussing earlier, is there some way for individuals to buy into this $36,500?

Or is there a pool where we can begin to figure out for those people who have retired?

Because it could be 20, 25 years for them.

And if there's something we can do to help care for people, it would be a very noble thing to come out of this conversation.

I think that's an excellent point.

I'll definitely make sure to bring that up.

Great.

Thank you.

I want to turn it over to Gee now so that he can tell you a little bit about the work that's done through his agency, Asian Counseling and Referral Services.

And again, he's been one of our great partners in the community.

Excellent.

Thank you, Kathy.

So ACRS has been around for 46 years now.

We've been in this chamber for many of the The bills that we've supported or direction that the city is taking, so we're grateful to have this opportunity.

We have various services, an array of services, social services provided through our agency from serving the aging population, behavioral health services from children and youth, family programs.

employment and training services.

These are the array of services that ACRS currently offers the community.

focusing on the Asian American Pacific Islander community, AAPAC community, but anybody who is in need of these services that ACRS can serve, we willingly serve, of course.

So my department, the Aging and Services Department, has several programs with the city of Seattle in partnership with Human Services Division and Aging Disability Services.

We have the congregate meal programs, our senior center, Club Bamboo.

in partnership with the city.

Our Title 19 case management program is also in partnership with the city and the Community Living Connections program that Kathy had mentioned earlier.

I wanted to maybe share a couple of quick stories of our clients maybe that we serve and how these programs really help them.

We have an 80-something-year-old woman who called Community Living Connections wanting to know a way to be outside of her home.

She lives alone, wanted to be active, wanted to be social and meet people and continue living a healthy life.

So she started, we referred her to our Club Bamboo Senior Center, she started coming regularly.

And in a particular week, our staff noticed that she hadn't been in for a few days, which was unusual for her.

So we had a welfare check done.

When the police got there, they found, we had to ask the landlord to let us into her unit.

We found her, she had fallen.

She was on the floor for those, three days or so without being able to get up.

So she suffered some dehydration.

They found her just in time.

And if not for the attentive staff of the senior center, that we may have missed that.

And so that's, you know, just a story, one of the stories that we have.

We're grateful for the dedicated staff that we have.

Another story is another elderly gentleman living alone started exhibiting symptoms of dementia and had to be asked to leave the house, the apartment he was living in.

And so he was in the process of being homeless.

Through the Title 19 case management program, And the help of back then, and hopefully coming soon, the Geriatric Regional Assessment Team, the GRAT, we were able to temporarily have him placed at the Geri Psych Unit at Northwest Hospital back then, and eventually placed in a nursing home where he spent the rest of his days here with us.

So, you know, these services are really critical to the communities that we serve, and it's great that we're able to provide them, but we do have challenges as providers in providing these services, and maybe this won't come as a surprise.

One is a matter of resource, and the other piece is a matter of workforce challenge.

So they're somewhat related to each other.

Let me talk about the workforce challenges.

For workforce, and this is, you probably heard it in the same chamber when you've had meetings with various social service providers, being able to provide competitive wages, living wages for our social service workers.

Seattle in particular, the county in general, really the cost of living has been going up faster than our wages have been, and this is not news.

And so for us to attract and retain qualified individuals who will provide these services has become a challenge.

The other challenge workforce related is we talked about the caregivers and the important role they play in long-term care.

There's a shortage of caregivers in general and for the communities that we serve at ACRS, the English language learners, the limited English proficiency seniors, that's even more because there's less, you know, when we talk about the Mien community or the Nepali community that would prefer to have caregivers who share their language and their culture, that's even a smaller pool.

And to attract those workers and retain those workers has been a significant challenge.

I think this is a statewide issue, if not a national issue.

So those are two of the workforce challenges and the resources that I've mentioned before.

Just the needs of the community is becoming greater and the resources have not kept up to pace with that.

We're grateful for the council for passing CB 119542 recently, the annual inflationary adjustment bill, which addresses some of the concerns about wages.

Unfortunately, Title 19 is not one of those programs that bill covers.

So the Medicaid reimbursement rate that we get from Title 19 case management is not enough to cover the cost, let alone the wages of our workers.

So the landscape of long term care is changing.

Providers like ACRS try to be agile and adapt to that.

but we're experiencing more and more that we're being asked to do more with less resources and I think as we've heard, you know, Washington State, our county, our city has done great in making these foundational investments and we hope to continue that the government and the city, the state, the county continues to support those investments so that we can continue to have healthy citizens living in our area.

Good.

Can I just have a quick comment?

Gee, thank you for that.

And we're sensitive maybe beyond what I can begin to articulate how important the work is that you're doing.

Thank you.

And I'm also keenly aware that $15 an hour plus a 2% raise, plus a 2% raise doesn't get you much.

And I want to acknowledge how difficult that is.

You're being asked to do more with less.

We hear that all the time.

So please know we appreciate what you're doing.

The stories that you talked about, the woman that had fallen and was alone for three days, we do know that social isolation is one of the worst things that can happen to our seniors.

So thank goodness for your people that were keeping an eye on that individual.

And I'm grateful to you.

And I wish I had a checkbook big enough just to take care of all of the woes and your challenges.

Yeah, I just wanted to add to G's comments because I've learned from Kathy, you always need to end with an ask.

There's a call to action.

We're here today because partly we want to sort of sound the alarm about this wonderful system that we've developed that's fraying, that's under stress.

We have not, Medicaid rates have not kept up.

We continue to educate the legislature every year with minimal success.

Sometimes we get small increases, but yes, in terms of particularly the costs of doing business in King County.

So we're all together as a team.

We're going to be advocating with the legislature this year to provide, and I feel like it's not only for our case management program, it's for our entire continuum.

I know you've already heard about the issue with some of the nursing home closures.

And, you know, there's a whole continuum of services that are needed.

And we've invested so much in this system.

And as we know, it's nationally recognized.

And what a shame if we don't continue to make progress, especially as the needs continue.

So we're looking for allies and advocates wherever we can for recognizing that need.

Thank you.

Thank you for bringing that up.

We were keenly aware about a number of the nursing homes and senior centers closing.

Earlier this summer, Allison McClain in my office had a relative she was keeping track of.

And this was really bad news because they were closing at the same time.

So if you had someone in a community where there was only one facility and then suddenly that facility closes but two others happened to at the same time, we're now dealing not with 100 people, but 300 people we're trying to find quality space for.

So thank you for your work.

Again, I'm stunned by how difficult and challenging this is.

Anything else that the three of you would like to bring up?

I think it's, as Kathy Knight mentioned, I think it's just really important for, you know, people who are viewing this and thinking about what they can do individually because it is easy to kind of throw up your hands and say, there's homelessness, we have housing affordability crisis.

But I, again, I go back to the fact that we all age and that, you know, we need to think about and care for our seniors now and in the future.

And talk to your legislator.

Talk to individuals.

They need to help hear from their constituents in their communities.

So I would like to be very specific about that.

You know, I cannot tell you how many times we hear, call your legislators.

But people want to know what do they say when they call.

So if you've got something specific, if you've got a bill, or as we're talking about here for long term, care if there's ways, things that you're doing that you would like us to emphasize.

I think that is a good opportunity.

We're happy to blog about this, to support you with some writing.

But it's helpful if we can, you know, back to your call to action.

People want to know what to do.

And if all they're like, well, call your legislators and the legislature, the legislators themselves are like, okay, well, I've just heard from 100 people saying we need more money.

One of the things that, because AARP, we're not involved in the financial fight, we are there to advocate.

And we have a very broad group of about 75,000 individuals.

We always want more people.

But we take on these issues, and we make sure that, you know, sometimes it's not a bill when it comes to budget.

And we want the legislatures to hear that, and they can join AARP.

They don't have to be a member, but they can get onto the list.

There is contact information for me, but they can also contact our office here in Washington State, ARP.org slash WA, we'll get you there.

And use your voice and advocate for your family.

I just got off the phone with a new advocate that's gonna be working with me.

I have a smaller core group of about 40, 50 people.

He's 35 years old and he wants to make his life better for himself, but most importantly for his grandparents and his mother and dad.

So it's, I'm like, there's, it's very rare to find a 35 year old.

I'm impressed for the reasons you talked about earlier, you know, at 35, you're still immortal.

You know, you're never going to get old and you probably are never going to get sick.

Joking for people who just, um, We are going back harkening to something that you said, how difficult it is to get people to pay attention to this and recognize that we are all getting older.

We need to be paying attention.

Thank you, AARP.

You're an amazing organization.

And I'm also very pleased to see that you are changing how the organization is perceived.

I got my AARP card when I turned 50 or whatever the age was, but now you guys are, I mean, you're fierce advocates and it's really good to see you.

Thank you.

We are in partnership with AARP on many of the issues and one of the Being an area agency on aging, we have an advisory council that's also mandated.

And they're advocates and very active and staying engaged and involved.

And we keep them busy during the legislative session.

And we provide information to our network.

Always happy to share that with you.

We'll be putting together our priorities, which will include these.

to get ready for the next session.

Great.

So if there's something we can do in my office, Lena is as much and is deeply dedicated to all ages and abilities and the kind of aging work you're doing, as I have been.

Let's see what we can do over the next month before budget gets started.

If there's something that you want us to focus on for the next few weeks, we're happy to do that.

And then it's budget, and then the end of the year comes fast.

It does.

Very good.

So do you have anything else you'd like to add while you're up here?

Do we have anybody else that wants to speak?

Well, again, thank you for all your work that you have done.

But you've been a really tireless, very passionate advocate.

when it comes to senior issues and creating age-friendly communities and livable communities for all.

Thank you for that.

I appreciate it.

I do appreciate it.

So if the three of you have nothing else that you would like to add, I think we made some public comment time.

Do I have anybody that would like to take a moment and give us your thoughts?

I don't see anybody rushing for the microphone.

Okay, well with that then we are going to adjourn a little bit early.

Thank you for that.

I appreciate it and all for your wonderful thoughts here.

Thank you for taking your time.

Lena, thank you for helping us organize it.

Okay, very good.

This meeting's adjourned.