Building Resilience in an Uncertain World
We live in amazing times! The centenarians among us lived through the Great Depression that started in October 1929 and resulted, at one point during the 1930s, in one in five people unable to find gainful employment.
There are elders among us who witnessed World War II in the 1940s, the Korean War in the 1950s, the Vietnam War in the 1960s and 1970s, and countless military conflicts since then.
Many of us were aware of and may have participated in the civil rights movement of the 1960s and beyond. The news seemed full of assassinations in the 1960s—President John Kennedy, Malcolm X, Dr. Martin Luther King, Jr., Bobby Kennedy, and more. In the past two decades, the news has seemed full of mass shootings in public places.
We’ve seen the rise and fall of local, national, and world leaders. We’ve seen tragic consequences of international terrorism and domestic insurrection. We continue to see the effects of climate change on our natural environment, including drought, flooding, and sometimes dangerously high levels of wildfire smoke.
We’ve all benefitted from the rise of technology—good and bad. Communication has never been easier. At the same time, I see deliberate misinformation (“fake news”) causing a high degree of disorder in our world.
Just over 100 years ago, the 1918 flu pandemic caused about 675,000 deaths in the United States over the course of two years. We’ve watched as more than 680,000 people perished from COVID-19 since we became aware of it in winter 2020.
Despite pandemics, longevity has increased about 25 years (on average) over the past 100 years, thanks to better nutrition, cleaner air and water, vaccines, and improved access to health care. Unfortunately, we do not have equal access to high-quality health care. Disparate income levels are largely to blame, and we are seeing an ever-increasing gap between rich and poor. The accumulation of wealth (and lack of it) too often correlates to race, ethnicity, and the zip code you can afford to live in.
Expect—and plan—for the unexpected
These somewhat random thoughts cause me to think about resilience—individual and community capacity to recover quickly from difficulties. I draw my family and friends closer and look for opportunities to appreciate the natural environment, creativity, and kindness. And I recognize the necessity of preparation—it’s a lot easier to bounce back if I anticipate and take steps to protect myself, my loved ones, and my community.
An issue that I think needs community attention right now is long-term care. There are two ways I hope you will consider preparing for the very real possibility that you or a loved one will need long-term care at some point in the future—the first is to participate, if you are still employed, in the WA Cares Fund; the second is to ask your elected officials to support a higher reimbursement rate for long-term care case management. Let’s explore those a bit.
WA Cares can help pay future caregiving costs
Washington State is the first state in the country to develop a long-term care trust fund. Starting in January 2022, employees will pay a small payroll tax that can help pay the costs of caregiving, starting a minimum of three years later. Read more about the WA Cares Fund in a recent AgeWise article (WA Cares to Help Meet Future Needs) and on the WA Cares Fund website.
One key point that deserves emphasis—if you opt out of WA Cares because you purchase private long-term care insurance, you will not be able to join the Fund later. I know people who already have long-term care insurance and are staying enrolled in WA Cares. For many wise people, it’s not an either/or, it’s a both/and.
Long-term care case management is a safety net
We are very fortunate to have a safety net for low-income elders and adults with significant disabilities that allows them to receive long-term care services and supports in their own homes. In fact, most older people do age in place in their own homes, if they can afford it. For those whose resources have diminished to Medicaid-eligibility levels, case management services are available through Area Agencies on Aging (like Aging and Disability Services, which provides long-term care case management services throughout King County).
Statewide, Area Agencies on Aging care for approximately 50,000 adults with complex needs in their homes over a long period of time. A quarter of those clients live in King County. While most are eligible to enter nursing homes, care in their own homes is far less expensive and far safer.
Average caseloads exceed 87 clients per case manager. They handle evictions, caregiver turnover, health crises, and suicidal thoughts. They address self-neglect, abuse, and family conflicts, and they protect clients in emergencies (excessive heat or cold, fire, flood, blackouts).
Area Agencies on Aging struggle to keep staff while state funding for the services they provide falls further. Meanwhile, a smaller number of elders who live in community settings (not their own homes) receive case management services from State DSHS employees, who are paid a higher wage.
I want state lawmakers to know that this is a safety net they cannot afford to underfund. These are their mothers, fathers, and grandparents, and families don’t have the resources to provide complex care.
We do our best to prepare for our eventual needs, but many individuals and families are struggling, and so are our social work professionals. Here’s my message to state lawmakers:
“Stabilize AAA Case Management with $12 million GF-S plus $12 million federal match to reach parity with state staff, adjusted in the maintenance level budget. Protect Parity in statute.”
If you feel inclined to contact your legislators about this issue, the toll-free Legislative Hotline number is 1-800-562-6000.
Contributor Dick Woo chairs the Seattle-King County Advisory Council on Aging & Disability Services. He welcomes input from readers via e-mail (firstname.lastname@example.org) as well as applicants for open positions on the council. For more information, visit www.agingkingcounty.org/advisory-council.
This article originally appeared in the October 2021 issue of AgeWise King County.