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Agency 300050
Long Term Care
RCW 18.20, .51, 26.44, 74.08, .09, .34, .36, .38, .42, .46

Request $1,777,626,000
Net change from current biennium $257,685,529 Increase
Percent change from current biennium 17.0% Increase


The Long Term Care program provides a broad range of social and health services to adults and older people living in the community or in residential care settings, including nursing facilities. These services are designed to establish and maintain a comprehensive and coordinated service delivery system. Special emphasis is placed on meeting the needs of functionally disabled older persons who, without assistance, are at risk of placement in a more restrictive living environment.

The Department implements long-term care services through Area Agencies on Aging and their service providers, Home and Community Service Offices, and offices for nursing home survey and client quality assurance.

The goal is to develop and maintain a comprehensive and coordinated service delivery system which enables people served to achieve a maximum degree of independence and dignity.


Links to Category Level Detail

Assistance Payments

Adult Services

Residential Care Quality Assurance

Aging and Adult Field Services

Special Projects

Program Support


Program Level Summary

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Operating Budget: Summary by Object

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries And Wages 22,772,218 30,570,129 32,534,457 34,195,953 36,111,561
Employee Benefits 5,759,849 7,818,848 8,227,799 8,797,593 9,084,047
Personal Service Contracts 207,854 518,018 232,800 620,393 243,800
Goods And Services 5,582,282 7,756,497 10,345,671 8,545,777 8,209,050
Travel 955,138 1,109,066 935,948 1,070,978 1,178,589
Capital Outlays 1,876,100 1,800,005 759,028 1,559,623 1,379,753
Grants, Benefits & Client Services 646,264,341 683,061,208 745,378,459 802,919,476 858,393,247
Debt Service 6,326 11,885 6,376 6,376 6,376
Interagency Reimbursements (6,943,512) (6,669,724) (6,600,000) 378,950 378,950
Intra-Agency Reimbursements 1,167,559 1,102,472 1,041,529 2,383,881 2,161,627

Annual Total

677,648,155


727,078,404


792,862,067


860,479,000


917,147,000


Operating Budget: Category Summary

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Assistance Payments 482,596,216 482,437,363 483,163,351 492,884,121 507,004,061
Adult Services 157,772,607 195,032,885 256,641,369 311,129,433 352,518,240
Residential Care Quality Assurance 8,814,000 10,051,904 10,507,936 11,629,498 12,004,188
Direct Aging and Adult Services 18,286,896 27,439,697 28,256,937 32,415,988 33,728,184
Special Projects 642,447 832,854 831,703 799,154 740,703
Program Support 9,535,989 11,283,701 13,460,771 11,620,806 11,151,624
Annual Total

677,648,155


727,078,404


792,862,067


860,479,000


917,147,000

Fiscal Year 1993-94 644,280,920
Biennium Total

1,321,929,075


1,519,940,471


1,777,626,000


Operating Budget: Change from Preceding Biennium

1993-95 Actual 1995-97 Estimated 1997-99 Proposed
Amount Percent Amount Percent Amount Percent
Assistance Payments 131,412,234 16.1% 15,854,628 1.7% 34,287,468 3.6%
Adult Services 49,117,096 19.4% 149,260,060 49.4% 211,973,419 46.9%
Residential Care Quality Assurance 1,314,000 8.1% 2,994,840 17.1% 3,073,846 15.0%
Direct Aging and Adult Services 3,676,554 11.8% 20,842,184 59.8% 10,447,538 18.8%
Special Projects 642,195 331.7% 828,728 99.2% (124,700) (7.5)%
Program Support (349,863) (2.1)% 8,230,956 49.8% (1,972,042) (8.0)%

Total

185,812,216


16.4%


198,011,396


15.0%


257,685,529


17.0%


Employment Summary

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 563.8 771.6 774.0 836.7 885.7
Average FTE Staff Year Costs 40,391 39,619 42,034 40,870 40,772


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - DSHS Social Service Fed Block Grant 3,809,800 3,810,200 3,686,800 3,687,200
General Fund - Basic Account - State 318,767,199 360,492,743 388,086,449 414,200,000 439,790,000
General Fund - Basic Account - Federal 358,506,114 21,285,374 19,354,902 21,661,932 20,289,000
General Fund - Basic Account - Federal Unanticipated 374,842 22,974
General Fund - Basic Account - DSHS Medicaid Federal 341,251,162 375,832,516 418,612,768 451,089,300
Health Services Account - State 216,351 5,778,000 2,317,500 2,291,500

Annual Total

677,648,155


727,078,404


792,862,067


860,479,000


917,147,000


Assistance Payments

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The Assistance Payments category provides nursing facility care to eligible persons who require short post-hospital recuperative care, are no longer capable of independent living and require nursing services, or are patients with chronic disabilities needing long-term habilitation and/or medical services.

Objectives are to: ensure that all nursing facilities are in compliance with federal and state regulations; ensure that all medical assistance clients in nursing homes receive quality care which reflects their individual needs; and control all nursing home program costs.



Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Grants and Subsidies 489,552,740 489,016,740 489,763,351 492,884,121 507,004,061
Other Operating Costs (6,956,524) (6,579,377) (6,600,000)

Annual Total

482,596,216


482,437,363


483,163,351


492,884,121


507,004,061

Fiscal Year 1993-94 467,149,870
Biennium Total

949,746,086


965,600,714


999,888,182


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - State 230,800,684 238,228,315 239,444,264 237,275,688 243,141,448
General Fund - Basic Account - Federal 251,795,532
General Fund - Basic Account - DSHS Medicaid Federal 244,209,048 243,719,087 255,608,433 263,862,613

Annual Total

482,596,216


482,437,363


483,163,351


492,884,121


507,004,061




Adult Services

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The Adult Services category includes payments for chore services, adult day health, residential care, nursing home discharge payments, the Community Options Program Entry System (COPES), Medicaid personal care, and aging services provided through Area Agencies on Aging (AAAs).

Chore services providers assist with household and personal care tasks such as shopping, meal preparation, bathing, or grooming to allow clients to remain in their own homes. The adult day health program is offered to people who do not require 24-hour institutional care but are not capable of full-time independent living. Adult day services include nursing care, social services, occupational and activity therapy, personal care, and nutrition.

Residential care is provided in adult residential care facilities and adult family homes for eligible individuals who require assistance and supervision in assuming responsibility for themselves in a daily living situation. An adult residential care facility is a licensed boarding home and does not provide medical or nursing services. In order to receive care in such a facility, a person must be eligible for Supplemental Security Income or Continuing General Assistance. Adult family homes provide a protected family-like environment to adult clients who require such protection due to physical disability, frailty, confusion, or emotional instability.

Nursing home discharge payments are designed to assist those residents of nursing homes whose conditions allow discharge in establishing an independent living arrangement.

COPES is the Washington State community-based care Medicaid waiver. Under COPES, services offered include adult residential care, adult family homes, personal care, and case management. Recipients are also eligible for medical services reimbursed by Medicaid and for home health or adult day health services to supplement primary COPES services. These services strive to prevent or delay nursing home placement.

Personal care services are provided to Medicaid eligible clients needing assistance with activities of daily living to remain in their own homes. Examples of services available range from assistance with bathing, feeding, and medication to protective supervision. Live-in care is also available in this program.

Services to the aging are provided by local Area Agencies on Aging (AAAs). Federal and state funds are supplied to the AAAs to directly serve senior citizens. Services include information and assistance, case management, respite care, adult day health, transportation, health screening, in-home services, nutrition services (congregate and home-delivered meals), employment, legal services, and minor home repair and maintenance services. Adult volunteer programs such as the Foster Grandparent and Senior Companion programs are also included in the array of services offered to aging citizens.

Objectives are to: maintain consistent, managed caseload growth in chore services; increase the number of clients served in the community by expanding the federally funded COPES program; and provide additional adult family home and assisted living beds for adults and older people.


Budget Unit Data

1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Title III Aging Services 13,016,508 11,653,638 12,914,294 13,180,594
Senior Citizens Services Act 8,153,506 9,627,706 9,633,695 9,627,706
Senior Companion Program 332,448 329,356 347,113 347,094
Community Svcs. Employ Older Americ 1,011,642 1,091,274 1,646,246 1,646,246
Respite Care 2,093,855 2,496,576 2,560,729 2,628,076
USDA Cash in Lieu of Commodities 2,030,149 2,100,000 1,962,370 1,962,370
Foster Grandparent Program 969,595 985,274 995,469 992,347
Private Duty Nursing 3,495,961 5,422,826 5,111,370 5,898,778
Chore Services 12,026,255 8,197,866 7,615,780 7,900,688
Adult Day Health 4,901,481 6,177,848 8,491,037 11,118,306
Adult Residential Care 1,630,390 1,366,585 766,058 800,722
Nursing Home Discharge 133,195 31,500 280,500 292,500
COPES 67,010,432 109,922,292 149,327,047 174,625,082
Case Management 9,058,732 12,752,984 12,700,158 12,790,676
Title XIX Personal Care 69,168,736 84,485,644 96,777,567 108,707,055


Category Employment

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 12.3 12.3 15.5 11.5 11.5
Average FTE Staff Year Costs 31,094 31,916 26,011 33,069 33,069


Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries and Benefits 493,178 505,480 517,565 493,135 492,975
Grants and Subsidies 156,316,565 193,617,482 255,249,405 309,631,535 351,023,483
Other Operating Costs 962,864 909,923 874,399 1,004,763 1,001,782

Annual Total

157,772,607


195,032,885


256,641,369


311,129,433


352,518,240

Fiscal Year 1993-94 144,641,587
Biennium Total

302,414,194


451,674,254


663,647,673


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - DSHS Social Service Fed Block Grant 3,809,800 3,810,200 3,686,800 3,687,200
General Fund - Basic Account - State 69,300,515 97,003,927 120,718,665 147,815,009 166,440,151
General Fund - Basic Account - Federal 88,472,092 17,006,303 15,758,894 18,151,731 17,236,499
General Fund - Basic Account - Federal Unanticipated 22,974
General Fund - Basic Account - DSHS Medicaid Federal 76,973,530 110,575,610 139,158,393 162,862,890
Health Services Account - State 216,351 5,778,000 2,317,500 2,291,500

Annual Total

157,772,607


195,032,885


256,641,369


311,129,433


352,518,240




Residential Care Quality Assurance

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The Residential Care Quality Assurance category performs oversight to assure quality care, patient assessment and cost containment in nursing facilities. Activities include surveys performed by nursing home surveyors and regular patient assessments by quality assurance nurses. Quality assurance activities also extend to adult residential care facilities and adult family homes. Fire safety inspections are performed under contract with the State Fire Marshal's office.

The objective is to continue these quality assurance activities in order to ensure the safety and health of patients receiving residential care.


Category Employment

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 135.9 146.0 146.0 167.0 176.0
Average FTE Staff Year Costs 42,995 45,750 45,750 45,210 44,876


Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries and Benefits 7,237,000 8,300,942 8,302,974 9,380,502 9,812,106
Other Operating Costs 1,577,000 1,750,962 2,204,962 2,248,996 2,192,082

Annual Total

8,814,000


10,051,904


10,507,936


11,629,498


12,004,188

Fiscal Year 1993-94 8,751,000
Biennium Total

17,565,000


20,559,840


23,633,686


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - State 3,940,000 4,493,202 4,721,110 5,263,579 5,455,167
General Fund - Basic Account - Federal 4,874,000 2,686,127 2,407,600 2,831,636 2,538,384
General Fund - Basic Account - DSHS Medicaid Federal 2,872,575 3,379,226 3,534,283 4,010,637

Annual Total

8,814,000


10,051,904


10,507,936


11,629,498


12,004,188




Aging and Adult Field Services

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This category supports the Home and Community Services Offices (HCSOs), which are the local arm of the Aging and Adult Services Administration. Specifically, these offices have the responsibility for Adult Protective Services and for determining client eligibility for the various services. The HCSOs also provide information and referral, nursing home placement, adult protective and case management services.

The objectives of Home and Community Services Offices are to provide a broad range of social and health services to adult and older people living in the community and in residential care settings, and to establish and maintain a comprehensive service delivery system which enables people receiving these services to achieve a maximum degree of independence.


Category Employment

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 314.1 469.0 469.8 533.8 574.8
Average FTE Staff Year Costs 38,335 37,109 39,397 38,176 37,790


Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries and Benefits 15,176,756 21,935,358 23,222,292 25,670,462 27,206,925
Grants and Subsidies 74 75
Other Operating Costs 3,110,066 5,504,264 5,034,645 6,745,526 6,521,259

Annual Total

18,286,896


27,439,697


28,256,937


32,415,988


33,728,184

Fiscal Year 1993-94 16,567,554
Biennium Total

34,854,450


55,696,634


66,144,172


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - State 10,134,382 14,774,430 15,949,317 17,516,595 18,668,239
General Fund - Basic Account - Federal 8,152,514 623,142 623,142
General Fund - Basic Account - DSHS Medicaid Federal 12,042,125 11,684,478 14,899,393 15,059,945

Annual Total

18,286,896


27,439,697


28,256,937


32,415,988


33,728,184




Special Projects

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Special Projects includes projects funded as separate items for a defined period. These include the Alzheimer's Disease demonstration project and the Seattle Housing Authority project. The Title XIX Ombudsman is also funded here.


Category Employment

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 0.6 0.5 0.4
Average FTE Staff Year Costs 33,045 32,566 23,508


Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries and Benefits 26,071 20,304 11,904
Grants and Subsidies 350,221 411,318 365,703 403,820 365,703
Other Operating Costs 266,155 401,232 466,000 383,430 375,000

Annual Total

642,447


832,854


831,703


799,154


740,703

Fiscal Year 1993-94 193,382
Biennium Total

835,829


1,664,557


1,539,857


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - State 186,454 75,000 125,000 100,000 100,000
General Fund - Basic Account - Federal 81,151 682,854 431,703 424,154 365,703
General Fund - Basic Account - Federal Unanticipated 374,842
General Fund - Basic Account - DSHS Medicaid Federal 75,000 275,000 275,000 275,000

Annual Total

642,447


832,854


831,703


799,154


740,703




Program Support

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This category includes program and policy development, technical assistance, program evaluations, payment processes, data collection and reporting and general administrative functions. Coordination between the Area Agencies on Aging and DSHS Home and Community Services Offices is facilitated through the Long Term Care program.


Category Employment

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
FTE Staff Years 100.9 143.8 142.7 124.0 123.4
Average FTE Staff Year Costs 44,458 42,265 48,656 47,402 49,526


Expenditure Detail

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
Salaries and Benefits 5,599,062 7,626,893 8,719,425 7,437,543 7,683,602
Grants and Subsidies 44,741 15,593
Other Operating Costs 3,892,186 3,641,215 4,741,346 4,183,263 3,468,022

Annual Total

9,535,989


11,283,701


13,460,771


11,620,806


11,151,624

Fiscal Year 1993-94 6,977,527
Biennium Total

16,513,516


24,744,472


22,772,430


Source of Funds

1994-95 Actual 1995-96 Estimated 1996-97 Estimated 1997-98 Proposed 1998-99 Proposed
General Fund - Basic Account - State 4,405,164 5,917,869 7,128,093 6,229,129 5,984,995
General Fund - Basic Account - Federal 5,130,825 286,948 133,563 254,411 148,414
General Fund - Basic Account - DSHS Medicaid Federal 5,078,884 6,199,115 5,137,266 5,018,215

Annual Total

9,535,989


11,283,701


13,460,771


11,620,806


11,151,624