“Caroline called yesterday to talk about her cat; about how she’s trying not to smoke crack; and about her blender, which I tried to help her fix the last time I saw her in person—now months ago due to COVID. Awhile back, she said she was moving to Oregon but that wasn’t true. Caroline has a hard time maintaining the small unit she lives in with her cat. She is sweet as can be but, due to mental illness, she really benefits from Medicaid Personal Care services. She gets the in-home support she needs and also benefits from our regular interactions.”
“Caroline” (names are changed throughout this article for privacy) is an Aging and Disability Services (ADS) client who receives in-home support thanks to the State’s Medicaid Personal Care program. ADS had 95 open Medicaid Personal Care cases in June. Many are younger and middle-aged adults; others older. Many have behavioral health diagnoses. Most would be unable to live independently without the support provided by this program.
Medicaid Personal Care assists individuals who have difficulty performing personal care tasks needed to live independently but do not require institutional care (for example, hospital or skilled nursing care or a facility for people with intellectual disabilities). Medicaid Personal Care provides help for people who qualify financially for Medicaid and cannot perform specific Activities of Daily Living like bathing, bed mobility, body care (application of dressings/lotions, foot care, etc.), dressing, eating, locomotion, medication management, toilet use, transfer and/or personal hygiene—skills needed to remain in their own home or to live in a community-based setting.
The main difference between Medicaid Personal Care and traditional Medicaid Long-Term Care is the number of ADLs required. Also, MPC has a lower income eligibility threshold and does not require nursing home eligibility. ADS provides in-home care to more than 14,000 Medicaid Long-Term Care clients every year.
MPC is authorized by DSHS Home and Community Services and Developmental Disabilities Administrations. When a client is referred to Aging and Disability Services, they are assessed by one of our case managers. We help determine the right level of support and assist the client in hiring a caregiver. We check in with them at least quarterly, adjust their care plan as needs change, and ensure that connections with housing, medical, and mental health professionals are in place.
Following are descriptions of several current clients and their situations—again, names are changed to protect their privacy:
- Bob, age 52, experiences profound effects from mental health issues and does not have awareness of his need to address activities of daily living like bathing, dressing, and personal hygiene. Declines in Bob’s overall condition occur rapidly due to paranoia and aggressive behavior; however, when his caregiver sees a behavioral change, they are able to alert mental health staff to keep an eye on him and also get a referral to a designated crisis response professional.
- Natasha, age 36, has mental health impacts and also developmental disabilities, and predatory people have tried to take advantage of her. Natasha benefits from regular interaction with a caregiver. Her caregiver is able to work with housing staff when her behavior changes, so they can keep an eye on her and reach out or intervene when needed.
- Art, age 37, qualifies for services due to his mental health condition. With caregiver services, he has become stable, and is doing really well.
- Bev, age 37, engages with her caregiver when she is stable but not in periods of decompensating, and this alerts staff to intervene with a designated crisis response referral.
- Fred, age 70, lives in the same apartment building as his sister but, due to her own health issues, she is not able to help. In-home Medicaid Personal Care services allows him to live independently and stay connected with his sister—his only local family member. He gets along well with his caregiver and is able to maintain his independence. His apartment is located close to his pharmacy and a grocery store. Prior to COVID, he also benefited from using the sauna at a nearby health club. He’s now on oxygen 24/7.
- Louise, age 66, had an initial diagnosis related to mental health. She qualified for Medicaid Personal Care in-home care that has allowed her to remain safe and relatively independent, living alone in supported housing with a strong sense of community. Safety and community are especially important for Louise as she is a multilingual Black immigrant woman. Louise has several sisters who live locally but they aren’t able to visit often. Neighbors help, and a caregiver keeps Louise company when others aren’t available.
- Mary, age 63, was diagnosed with bipolar disorder, borderline personality disorder, intellectual disabilities, and diabetes. Until a few years ago, Mary lived in a supportive group home with other adults who had intellectual disabilities and behavioral health issues. Unfortunately, the house closed due to funding cuts. Fortunately, Mary was able to move into an apartment with a roommate and was eligible for Medicaid Personal Care. She has a caregiver who comes once or twice a week to help with household tasks. Mary is independent in a lot of ways but, like most of us, flourishes with regular support. Mary’s family lives in another state so her caregiver and her behavioral health team are her constants. She’s is a great conversationalist! Recently, Mary shared that she has learned how to become a better advocate for herself and wants to find ways to pass along these skills to other people with disabilities. As her case manager, I helped her come up with ideas about how to do this and she plans to follow up with the help of her peer counselor.
Medicaid Personal Care is one of the programs that the State of Washington may cut due to budget shortfalls. I’ll ask the same questions posed by ADS Advisory Council chair Ava Frisinger in Federal Advocacy Needed Now More Than Ever (AgeWise King County, August 2020):
- Where would you turn if you or your loved one could no longer receive in-home support?
- Where would you turn if you or a loved one with developmental, intellectual, or other disability that qualified for Medicaid health care services was suddenly cut off?
- How would you ensure your or their health and safety?
It’s difficult to say exactly what would happen if State funding for Medicaid Personal Care gets cut. But given our clients’ current resources—family, financial, and otherwise—it’s safe to say that many would end up without shelter or in a higher, more expensive level of care.
We care about our clients and don’t want that to happen. And we’re positive that this kind of displacement would cost taxpayers much more in the long run.
Learn more about the new Long-Term Care Coalition that’s advocating for more funding for long-term services and supports. Sign up for advocacy alerts from AARP Washington and the Washington Association of Area Agencies on Aging (w4a).
Contributor Theresa Tanoury directs the Case Management Program at Aging and Disability Services—the Area Agency on Aging for Seattle and King County—which includes Medicaid Personal Care, Medicaid Title XIX, Medicaid Transformation Demonstration Project, Family Caregiver Support, and more, serving individuals and families throughout King County. For more information about case management services, call Community Living Connections toll-free at 844-348-5464 or visit CommunityLivingConnections.org.