ANALYSIS OF HOUSE BILL 2454

  Providing a program to support family and other unpaid long-term caregivers.

Health Care Committee                          January 26, 2000

Washington State House of Representatives

SPONSORS:  Representatives Edmonds and Parlette.

BACKGROUND:  As the first wave of baby boomers enter their mid-50's, an increasing number of their parents are moving into the ranks of what is called the Aold-old@ where disability and the need for daily care becomes increasingly likely.  Data indicate that one out of four persons over the age of 80 will require nursing home care.  Before they are admitted into a nursing home, however, family members usually have been providing daily care for some time.  These unpaid family caregivers most often are females (72 percent).

Unpaid family caregivers are persons who provide unpaid help with personal needs or household chores to a relative or a friend.  Approximately 80 percent of all long-term care in this state is provided by unpaid family caregivers.  In Washington state, this translates to an estimated 504,272 caregivers.  One-quarter of the caregivers provide intense caregiving of at lease 20-40 hours per week, amounting to 502,900,000 hours of care.  Area Agencies on Aging estimate that if the work of these caregivers had to be replaced by paid home care staff, the cost to the state would have been approximately $4,113,600,000 in 1997.

A recent study by the American Society on Aging indicates that Acaregiving exacts an enormous emotional and physical toll including immense stress, high rates of depression, and feelings of anger and anxiety@.

The state respite program provides unpaid family caregivers a limited range of care options to assist them with their caregiving activities or to provide a paid caregiver to provide them with temporary in-home assistance.  Services provided under the Respite Program include:  respite assessment and care plan; hourly and daily respite care; planned and emergency episodes; and in-home and out-of-home service options.  Levels of care include:  supervision, personal care and nursing care; services appropriate to persons with dementing illnesses; or neurological disorder including traumatic brain injury are also provided.

The caregiver is the client in the respite care program.  The caregiver is a spouse, relative or friend who provides care and/or supervision on a daily basis for an adult who is functionally disabled.  The caregiver does not receive financial compensation for the care and is assessed as being at risk of placing the eligible participant in a long-term care facility if respite care and other support services are not available.  The Area Agencies on Aging (AAA) receive funding from Aging and Adult Services to administer the Respite Care Program.  Case managers from the AAAs perform an assessment of both the caregiver and of the participant (adult who is functionally disabled).  The Respite Care Program received statewide funding (State General Funds) beginning in 1989.

The Department requires eligible participants to pay part of the cost of the respite care services received.  There is no charge to the participant if his or her income is at or below 40 percent of the State Median Income.  If the participant's income is between 40 and 99 percent of the State Median Income, he or she is charged a percentage of the cost of respite care.  This amount is calculated using a sliding fee schedule.  If the participant's income is 100 percent or more of the State Median Income, he or she pays the full cost of the service.  The cost of respite care is determined by the number of hours or days of respite care authorized and used.  The caregiver is not means tested or required to pay for the care received.

Total number of caregivers served:  2,712.  Total number of respite service hours:  244,700.  Average cost of respite care per hour:  $9.91.  Cost includes administration, coordination, assessment and service.

SUMMARY:  Functionally disabled adults at risk of being institutionalized in a long-term care institution, if not for the help of unpaid family members or friends, are allowed to have  information and support services provided to relieve or assist their unpaid caregiver.  The type of services and information that is provided to unpaid caregivers by local Area Agencies on Aging are outlined and must be provided with the intent to maintain the unpaid caregiving at home for as long as possible.

APPROPRIATION:  $1,000,000 (GF to DSHS).