Home-Based Long-Term Care in Washington State

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  • Deep health cuts pose a threat to the health of vulnerable seniors
  • “An aging population and chronic illnesses are costly challenges to the American health” (Kinner & Pellegrini, 2009, p. 1781)
  • In-home care less costly than institutionalization (nursing homes)
  • Cuts will impede support services for people with long-term care (LTC) needs:
  • Dressing
  • Feeding
  • Bathing
  • Reform will have significant cost savings for the state
  • Seniors will receive cost-effective care in their homes/communities
  • Less emergency visits
  • Less hospitalization/institutionalization

The proposed public health budget cuts will affect the well-being of the people, especially the elderly. Long-term care (LTC) is one of the services that will be affected by the cuts. Since 2009, Washington has had accumulative budget cuts amounting to $3 billion. The cuts have left many seniors in a distressing state, as they now receive less home-based care. This has forced some seniors to go for other coverage plans.

The Proposed Cuts

  • Tightening of eligibility requirements for LTC services
  • Spending will be reduced by $8.3 million
  • 1600 seniors will be affected
  • Adult Day Health Program
  • The budget will be cut by $4.5 million
  • Affects rehabilitative services for the disabled elderly
  • Home care agencies
  • Cuts will amount to $8.8 million
  • Over 12,000 seniors will be affected
  • Reduced funding to Local Agencies on Aging
  • Reduced by $1.6 million
  • Ombudsman office grants reduced by $327,000

The proposed cuts will affect a range of long-term care services. The new eligibility guidelines will render many seniors ineligible for the home-based long-term. It will also affect seniors receiving assisted care in Adult Family Homes. The Adult Day Health Program offers rehabilitative services to disabled seniors. If the program is discontinued, families will be forced to take care of their aging relatives. Home care agencies provide home-based care that is less costly compared to nursing home services.

Costs/Benefits of LTC Service

Long-term care (LTC) in Washington has been quite successful largely because of the state’s focus on home-based care. Home-based care is cost-effective and popular among seniors. Washington State, through the Adult Day Health program, supports care delivery by family members. The benefits of this service include cost-effectiveness (rated 32nd in the per capita budget), the reduced caseload in elderly homes, significant cost savings, and improved care coordination. Compared to the other alternatives, i.e., nursing homes and emergency room visits, home-based LTC is less costly and has many long-term benefits.

Cost-effectiveness: Home-based Care Vs. Other Options

On average, a client in a nursing home pays $138 daily, which is relatively higher than the cost of home-based care ($53). On the other hand, emergency care, which serves seniors with complicated illnesses, is even more expensive ($300). Thus, it is evident that home care is more cost-effective compared to the other options. Washington’s focus on LTC offered within community settings generated 45% in cost savings in 2007 compared to 82% in 1993. Thus, budget cuts on home-based care will reverse this trend.

Benefits: Extended coverage

The 2007 recession coupled with a slow economic recovery and a high unemployment rate has left many people (particularly seniors) with no insurance cover. Home care is the best alternative for low-income seniors, who are ineligible for Medicaid coverage and cannot afford nursing home services or emergency care. Thus, LTC care offered within home settings meets the needs of the people who need it and prevents them from seeking the costly services of nursing homes or emergency care.

Coverage for the Uninsured

The available insurance plans are not affordable leaving many people without insurance cover. In Washington State, the number of the uninsured stood at 880,191 in 2010 up from 711,257 in 2006. This population includes low-income adults, seniors, and the disabled, who lack home care, as they cannot afford LTC services.

Reduced Strain on Hospitals

Hospitals located within community settings provide preventive care to low-income individuals and the uninsured. Because of economic challenges, people prefer CHCs to nursing homes and specialist clinics. They offer quality care to patients within their homes or community settings. Thus, they reduce the strain on Washington’s health care system, as care is delivered in people’s homes.

Expected Impacts of the Cuts

The cuts will affect different categories of people. In particular, seniors, low-income individuals, and the uninsured will be worst hit by the proposed cuts because they entirely depend on home care services offered by CHCs. The cuts will affect them in many ways. First, the stringent eligibility requirements will lock out many people. In addition, cuts will increase the demand for private adult homes, which will lead to higher prices. Consequently, low-income seniors will be forced out of elderly homes.

Impact on Family Caregivers

Family caregivers will also be affected by the health cuts. Research evidence shows that family caregivers are often employed women aged 49 who have to spend over 20 hours a week caring for their elderly relatives. The elderly have complex health care needs that need specialized care. Family caregivers, without the support of CHCs, will not be able to provide quality care to their loved ones.

Impact on Adult Protective Services

The proposed health care cuts will force low-income seniors without any family members to stay alone. This will increase the risk of fall-related injuries, as the frail elders and the disabled cannot walk without assistance. It will also lead to self-neglect, whereby the elderly fail or forget to perform activities of daily living, such as bathing, eating, and dressing. This will translate to lower health outcomes for this age demographic. Law enforcement will spend more resources responding to desperate calls for assistance from elderly people.

Impact on Health Spending

Home care encompasses preventive physical and mental medical services. The proposed cuts will cause the health of the seniors to deteriorate much faster. As a result, more elders will develop complications that will need case management, which is very costly. Moreover, nursing homes will receive more clients in need of mental and physical health care. Ultimately, it will become expensive to treat mental disorders and old age-related conditions.

Effect on Healthcare Infrastructure

Cuts will increase the demand for adult care services. This will result in long waits to receive care, which will have negative effects on the patients’ health care outcomes. LTC facilities and hospitals will also be strained financially due to the low budgetary allocation. Staff layoffs will be the main approach the centers will use to cut down their expenditures. On the other hand, increased workload caused by the high demand for adult care will lead to staff turnover.

Impact on the Healthcare System

Washington’s health care system is another area that will feel the pinch of the proposed cuts. Previous cuts have significantly weakened the State’s health care system, especially with regard to basic health care provision. The cuts since 2009 have accumulated to $3.1 billion.


In conclusion, it is clear from the analysis that budget cuts will make long-term care more expensive for the state. Home-based care is cost-effective, broad in its coverage, and has significant cost savings. Short-term solutions to the budget deficits, such as health care cuts, will be costly in the long term. Therefore, policymakers should explore alternative sources of revenue to fill up the budget deficit.

Alternative Proposal

An alternative proposal to the budget cuts (home care) encompasses policy changes to generate revenue within the LTC system. Under the community-first approach, an FMP increase of six percent imposed on all LTC facilities will generate up to $30 million for the state. A second approach may involve an increase in the cost of obtaining a senior center license. This will generate an estimated $1.3 million.


Smith, A., Minyard, J., Parker, A., Van Valkenburg, R. & Shoemaker, J. (2007). From Theory to Practice: What Drives the Core Business of Public Health? Journal Public Health Management Practice, 13(2), 169–172.

Kinner, K. & Pellegrini, C. (2009). Expenditures for Public Health: Assessing Historical and Prospective Trends. American Journal of Public Health, 99(10), 1780-1791.

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1. BusinessEssay. "Home-Based Long-Term Care in Washington State." April 27, 2022. https://business-essay.com/home-based-long-term-care-in-washington-state/.


BusinessEssay. "Home-Based Long-Term Care in Washington State." April 27, 2022. https://business-essay.com/home-based-long-term-care-in-washington-state/.