Our state's long-term care crisis needs much more than a hearing

I'm not an early riser; in fact, I'm allergic to anything serious happening before, oh, 8:30 a.m.

So, when I got up last week at 5:30 a.m., made the five-hour round-trip commute to Olympia and sat through a day of testimony, all unpaid, you know I thought it was important.

The event was the opening of the governor's Long-Term Care Task Force, a new initiative "to develop recommendations on public and private mechanisms for financing long-term care, particularly in rural communities," said Gov. Christine Gregoire, and to manage or prevent chronic diseases to reduce future long-term care costs.

I made the same trip last spring to testify in its favor, so I wanted to see how things were going.

To say I was disappointed is an understatement.

Long-term care costs are increasing rapidly, and the Puget Sound area has the fourth-highest costs in the nation. Medicaid (for the poor) is its largest source of public funding, as well as the fastest-growing segment of most state budgets. An estimated 50 percent of our state's population will need long-term care someday. The number of people 65-plus is expected to increase by 84 percent in the next 15 years — the highest rate of projected increase in the nation.

Even beyond these basic numbers, however, I believe our long-term care system is simply "broke."

Most of us rely on the government to take care of us — when it can't — and few of us plan for our own care — some of the most expensive, important, emotional and complicated transactions we'll ever experience. No one in authority tells us to save for the occasion, buy insurance, shop for care before there's a crisis or "kick tires" to select the best providers. It's a classic case of buyer beware — with no guidance from anyone.

It's also a perfect storm: High demand, consumer ignorance, crippling budget decreases (soon to be exacerbated by fierce federal cuts) and millions of aging baby boomers soon will make the situation dire.

None of this is new. Since the mid-1980s, our state has had five major hearings, committees and studies focused on our troubled long-term care system — to little avail.

So as I sat listening to the experts last week, I sensed déjà vu: been there, done that. When will we try something new?

The 800-pound gorilla in the room was the Department of Social and Health Services, the extremely powerful state agency that oversees Medicaid, licenses residential providers and sets the marching tune for virtually every long-term care service in the state. Many speakers declared their devotion, claiming it's "one of the best" agencies in the country.

But where was the balance? DSHS is despised in many quarters, with good reason — where were the dissenters? Where were speakers who could talk about topics beyond Medicaid and DSHS, as the governor's initiative calls for?

Here are some of my politically incorrect thoughts.

• Bravo to DSHS for allowing disabled Medicaid recipients a wider array of care options than nursing homes (most other states do not). This doesn't make our state the best, as much as it shows how far other states fall short. We still have a long way to grow to meet the needs of our new century, and it will require tough, bold steps, not the tiny ones that providers and DSHS have long taken.

• The day's testimony focused solely on Medicaid. But true solutions in long-term care will come only when we understand the entire system — including the private-pay sector (the one group in the market with the leverage to bring changes). One of the task force's mandates is to find private funding mechanisms, yet there was repeated bashing of long-term care insurance and reverse mortgages, two key private funding mechanisms.

But of all my recommendations, here are the two most important:

• Rather than rely on government, we must make families and older people responsible for their own long-term care decisions. This piece has been missing from the long-term care system since the beginning, and it'll never get better until consumers become stronger and more powerful. A key ally could be Senior Information & Assistance — a free, tax-funded referral service in almost every county in the state that is now woefully out of date and inadequate.

• As consumers become stronger, we must reduce the command-and-control regulations that have stifled competition and innovation among providers for the past 30 years. If regulations were the answer, nursing homes would be the first choice of most Americans, since they're one of the most over-regulated industries in this country. Instead, we're going in the opposite direction. Recently, DSHS added a whole new layer of regulations to assisted-living facilities. Here's an example of how these new regulations "protect" us: A new, well-run retirement community applied several months ago to DSHS for licensure, but the application was rejected. Why? The word "the" was missing from its name.

In 20 years, as millions of aging boomers need care, I fear we'll be wringing our hands over how terrible our long-term care system is — just as we do today about schools — and wondering why we didn't do better.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she's worked with thousands of families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.