Washington State Raises Adult Family Home Licensing Fees - Again.

She's done it again; Governor Christine Gregoire's budget raised licensing fees for adult family home providers from $175 to $220 per bed, per year beginning July 2013. 

And beginning July 2014, it will go up again to $291 per bed, per year. That's a 26% increase from last year, and by 2014 this will amount to 66%. Just 3 years ago, licensing fees were $100 per year, per home - not per bed.  Total increase to date: 1220%.

Now let's keep in mind that DSHS has also CUT daily reimbursement rates by 4% in 2009 and we've seen no increase since.

And like everyone else, we've seen significant increases in cost of living thru-out Washington state, especially relative to food, water usage, gas, electricity and other utilities, and significant liability insurance increases.

Let's do some basic math.

The average reimbursement rate from the Medicaid program to an adult family home provider in Washington State breaks down to about $3.75 per hour (average daily Medicaid reimbursement rate being about $90 per day).

Now let's multiply this by 6 residents - the state limit per care home - that comes to $22.50 per hour.

Let me ask you this: if you were a nursing assistant with the expensive training required, how much would you want to be paid per hour to help care for 6 residents?
- Pick a number;
- Now let's subtract your pay from the $22.50, what's left?
- Now add: mortgage, utilities, food, insurance, payroll taxes, drive them to the doctor, run 24/7/365, etc. etc.
- Oh, pay the provider...
You get the idea.

Interestingly, DSHS does look at care provider's ability to have sound financial footing, but there are no clear guidelines as to what that is, at least nothing concrete that a care provider can refer to.

So here are my predictions for the next 24 months.

As more and more Medicaid-serving adult family home providers struggle to make ends meet on a shoe-string budget, more DSHS inspectors enforcing rules (rather than providing technical assistance), we'll be seeing:

1. more citations for AFH providers who serve Medicaid clients
2. more frustrated and struggling providers leaving the profession 
3. more families struggling to find care providers willing to accept Medicaid residents
4. a renewed increase in the use of nursing home for the poor Medicaid recipients
5. a more select audience who can afford the better quality care - albeit more expensive - alternative that AFHs offer.

So what are we learning? 

1. The flavor of the decade hasn't changed; more cuts to social programs and for those who need it most, increased costs for small business owners. The excuse hasn't changed either, somehow "not enough money."
2. Adult family homes are an essential part of our long term care system, and the preferred consumer setting for the frail elderly who need assistance. It's a home, and many provide top-notch care through the end of life. But it can't be done without money. Fund the program as it needs to be, or go back to the extensive use of nursing homes and leave the AFH option as the high-end alternative for those who can afford it.
3. If your age dictates it, consider long-term care insurance! The bulk of long-term care is provided and received in licensed residential care settings, NOT assisted living.
4. Plan ahead. If you or your parent is running low on funds, take some steps as early as possible to figure out where you/she may receive care if needed.