The Washington state Department of Social and Health Services has rolled out new services for unpaid caregivers. 

Bea Rector, Olympia-based director of the home and community services division within the Aging and Long Term Support Administration of DSHS, says the services are designed to help at-home clients and care recipients and may also have financial savings.

The two new programs—one is Medicaid Alternative Care, and the other is Tailored Supports for Older Adults—build onto DSHS’s longstanding Family Caregiver Support Program.

Lynn Kimball, executive director for Aging & Long Term Care of Eastern Washington, says MAC helps caregivers 18 or older who care for someone 55 or older. TSOA supports people who are 55 or older, regardless of whether they have a caregiver.

Rector says there are about 850,000 unpaid family caregivers in Washington state. Although the state already provides long-term care and support services for people who qualify for Medicaid, the growing number of aging adults also has to be taken into consideration. The population of people 65 or older will double within 20 years, she says.

“We’re really thinking about, how do we cost-effectively meet the needs of this growing population, when we know that in our state and federal budgets there’s not really room to double budgets in that time period.” 

“One of the things that we know is, people want to stay at home as they age, and families typically want to provide that service to their loved one,” she says. “We have not under Medicaid been able to pay for supportive services to an unpaid family caregiver, so that’s really the focus of these services.” 

She says family caregivers provide $10.6 billion worth of care per year statewide, which is five times what Medicaid spends in Washington state to provide long-term services and supports.

At-home unpaid family caregiving is also nearly one-fourth the cost of using a paid caregiver. On average, paid caregivers through Medicaid cost about $1,900 per month. Wrapping services around an unpaid family caregiver costs about $550 per month, she says. 

She says MAC is a program for people qualified for Medicaid. TSOA is geared toward people who otherwise have too many resources to qualify for Medicaid.

The latter program targets that population because long-term care can be expensive, “and people quickly impoverish themselves” when having to pay out-of-pocket for long-term care, says Rector.

Offering certain services, like those of MAC and TSOA, to people in that population will “allow them to take the limited resources they have and maintain themselves in their own home and will delay or prevent the need to spend down to qualify for Medicaid,” she says.

Like the Family Caregiver Support Program, Aging & Long Term Care of Eastern Washington subcontracts MAC and TSOA assessments and resources through Elder Services of Spokane, a division of Frontier Behavioral Health.

Christy Vlasak, senior family caregiver support specialist with Elder Services, says MAC and TSOA differ from traditional long-term care programs because they focus on both the caregivers’ and the care receivers’ needs, rather than just the latter.

The program launched in September and will run for five years, “with the hopes that we can show the cost savings from helping unpaid caregivers keep their care receivers longer,” she says.

MAC and TSOA have three levels of service, she says. Level one qualifies caregivers for up to $250 for one-time only to put toward services. Level two allows up to $500 per year. Level three qualifies caregivers for $550 per month for services, not exceeding $3,300 for six months. 

So far, Vlasak says 25 people are enrolled in either MAC or TSOA.

Which service level an individual receives depends on the results of a tailored care assessment and referral, says Vlasak. The assessment-and-referral protocol was developed by the University of Wisconsin and also is used for the Family Caregiver Support Program. It often is conducted via phone, and then followed up with an in-home meeting.

Services can include consultations, education, or trainings for caregivers or other TSOA recipients that relate to caregiving needs. It also can include different respite services, such as massage therapy for those who qualify or short-term respite to enable caregivers to attend other service events, she says. 

Rector says clients who qualify can put their benefit amount toward purchasing medical equipment or supplies for their care receivers as well. 

For individuals that qualify for TSOA but don’t have a caregiver, services are similar, she says. For example, clients can attend consultations, educational events, or trainings, and they can also use funding to put toward medical equipment or devices. 

She says there are several services that can be provided, but it varies from area to area based on the contractors. Spokane has a lot more resources than other areas, she says.

Rector also names some examples of services offered. They include training on safely transporting a loved one, and what to expect from a dementia diagnosis.

As caregiving becomes something family members spend more of their daily time on, other services also can be provided. An example Rector gives is respite, where the caregiver is given a break and can engage in activities like getting a haircut or attending a doctor’s appointment, she says.

“Those kinds of services are really key to being able to keep a loved one home and safe while also trying to meet the health needs of the caregiver,” she says.

Kimball says, from a client’s standpoint, the services won’t be much different than the already established Family Caregiver Support Program.

“The program will look very similar to clients. A lot of the differences is all in the background, such as payment methods,” says Kimball.

The Family Caregiver Support Program allows for broader population eligibility. It consists of people caring for someone 18 or older, rather than 55 or older, and isn’t confined by the financial restrictions MAC and TSOA are. People screening for these services work with Elder Services, a division of Frontier Behavioral Health, to go through TCARE and set up a resource plan. MAC and TSOA also do this, she says.

Rector says MAC and TSOA came about as a way to leverage Medicaid funding to reach more people who need those services.

Kimball says, MAC and TSO are part of the Medicaid Transformation Demonstration, which means MAC and TSOA are funded through a special federal demonstration program. The Family Caregiver Support Program is funded through other state and federal sources.

Aging & Long Term Care of Eastern Washington is the local Area Agency on Aging that works with DSHS to provide certain services, such as helping care receivers stay at home longer, she says.

Rector says, “Just a little bit of service … can go a long way to build the confidence of the family caregiver to feel like they can meet the needs of their loved one.”