The name of the game is defense for advocates of the the long-term care industry as they do battle during Washington's legislative session this year.

As the Legislature tackles a supplemental budget for the remainder of the current biennium, policy matters related to long-term care will take a back seat to efforts to keep funding intact where possible, industry experts say.

"We don't really have any policy issues because the Legislature is so focused on balancing the budget," says Gary Weeks, executive director of the Washington Health Care Association, which primarily represents for-profit long-term care providers.

"What I liken it to is, when the house is on fire people aren't as concerned about the pipes bursting," says Sen. Chris Marr, D-Spokane, who is a member of the Senate health and long-term care committee.

After last year's legislative session resulted in deep cuts to Medicare nursing home reimbursements, which currently are on hold due to a temporary restraining order secured by the Washington Health Care Association in federal court, the association has worked to help craft legislation to make up for the cuts. It wants to add a fee for each nursing home bed day, which would allow the state to take advantage of matching funds through the Medicaid program.

The nursing home industry is seeking approval to institute the new quality maintenance fee that would be put into a trust fund along with federal Medicaid matching funds to help cover nursing home rates.

The association hopes that even though it can't backfill the cuts made last year, the additional Medicaid payments would help restore some funding to providers, Marr says.

Weeks says that if the fee is passed, the Washington Health Care Association would drop its federal suit, which would allow last year's budget cuts to stand.

Meanwhile, Weeks says the association is opposing what it believes are too-steep license-fee increases proposed in Gov. Chris Gregoire's budget, including a 19 percent annual license-fee hike for nursing homes, and a 44 percent license-fee increase for boarding homes.

Another budget issue under consideration this session, Marr says, is a proposed reduction of 500 adult day health slots throughout the state through attrition. That change would save the state about $13 million, but ultimately would be costly in the loss of local services or the cost of restarting such services once the budget improves, he says.

Jim Lippold, executive director of Providence Adult Day Health, in Spokane, says he is continuing to lobby lawmakers to preserve those slots. What the change would mean to seniors here is that no new clients who live in residential-care settings would be approved for reimbursement for services offered at centers such as Providence Adult Day Health.

Last year, the Providence Adult Day Health program reeled from the loss of about 70 percent of its state funding and closed one of its two Spokane locations, but its parent organization, Providence Health Care, decided to continue providing services to all of its clients despite the cuts. Collectively, Washington state recipients of state funding for those services won a class-action lawsuit against the state and had their services restored. Marr says, however, that the matter remains in the courts, and the proposed program reductions over time won't be affected by the outcome. Lippold says that by the time the 55 affected clients here were restored to service, some transportation providers, who had been paid by the program to transport patients to and from the adult day health centers, had closed or sold their vans. Some were able to make other arrangements to get to the center, in some cases riding on the Spokane Transit Authority's bus system, but some couldn't get to the center at all.

Other programs being considered for cuts this session fall under the state Senior Citizens Service Act. In the first iteration of Gregoire's proposed budget, funding for the act was trimmed by $7 million.

"The Senior Citizen's Services Act is basically designed to keep folks in their homes," under the premise that it costs less to keep people in their homes than to reimburse for their care in senior centers, and that it also uses state funding to augment local resources to pay for services such as Meals on Wheels, in-home visitation, and counseling for seniors so they can remain in their homes, Marr says.

Funding for the act has been brought back in the governor's revised proposed budget, but only if revenue can be found to pay for it, Marr says.

At Aging & Long Term Care of Eastern Washington, a number of programs would be drastically affected if those earlier suggested cuts under the Senior Citizens Services Act are brought back, says Nick Beamer, executive director of that agency, which oversees or administers about a dozen programs that serve the elderly here.

"Our adult day-care program, our bathing assistance program, our minor home repair, information and assistance program, and case management for people who are not Medicaid eligible—these are all programs that we use our Senior Citizens Services Act to fund, and would be drastically cut back if the 65 percent cuts were to reappear," Beamer says. "Our focus right now is on the Senate and House as they develop their budgets, to be sure that doesn't occur."

One program that is slated to be cut in the current proposed budget is the senior information assistance program, which helps match seniors with in-home caregivers who have been through background checks. Beamer says if that program's funding is cut, many people will have no choice but to seek in-home care through agencies, which he says can cost as much as $5 an hour more than in-home care through individual providers.

Though there is more need for senior services, it continues to be a difficult climate to promote any policy changes, because the budget remains at the forefront, Lippold says.

Marr says one of the main reasons senior programs continue to face further cuts is that despite reduced resources, the Legislature last year affirmed a commitment to protect K-12 education programs, leaving other social areas, such as long-term care and higher education, in competition for remaining resources.

Beamer says that despite the overwhelming focus on budget issues, the state attorney general's office is seeking legislation that would strengthen protection for seniors against elder abuse.

"That's clearly a need and I'm glad the attorney general's office is stepping up to the plate and proposing laws and changes that would help protect seniors," Beamer says.

Weeks says that future policy issues include a possible effort to allow a new class of health-care workers, called medical technicians, who aren't nurses but could administer medications, which he says could save the industry money. In the current climate and with a short legislative session, however, such efforts have been put on hold until at least 2011, Weeks says.