‘Silver tsunami’ may swamp long-term care

Demographers have long warned a “silver tsunami” of baby boomers would overflow nursing home capacity. That time is nearing.

Already, 122,664 Clark County residents — 23 percent of the county’s total population — are older than 60, according to the most recent U.S. Census figures. Meanwhile, Clark County has eight skilled nursing centers with a combined 744 beds, according to the Washington State Department of Social and Health Services. There’s little prospect of adding more and strong possibility the number will dwindle.

“Nobody wants to build a nursing home,” said Dianna Kretzschmar, regional health services liaison at Vancouver Specialty and Rehabilitation Care. “They’ll build an assisted living for private pay, but nobody wants a nursing home. They’re expensive. The math doesn’t work.”

Unprepared

People often don’t think about long-term care until it is too late because they don’t think the effects of aging will catch up with them, Kretzschmar said.

About 70 percent of adults who reach age 65 will need some type of long-term care services before the end of their lives, according to studies by the U.S. Department of Health and Human Services. Fifteen percent of people will need to spend at least two years in a skilled nursing facility.

Nursing home care costs so much that older adults often deplete their bank accounts and must rely on Medicaid to cover the bill. The average cost of a semi-private room in a Washington nursing home is $12,714 per month out of pocket.

“If Medicaid stopped paying for long-term care, a resident’s family would need to come up with the $12,000/month needed to keep them safely in the nursing home, rather than at home without the proper care or even on the street,” according to a report from U.S. Sen. Maria Cantwell, D-Wash.

An analysis from Opera Beds, which is a home hospital bed company, found Washington to be among 10 states that are least prepared to care for its aging population. In the past decade, Washington has lost 12.27 percent of its nursing facilities, equivalent to one closure about every four months.

Although no centers have closed in Clark County since 2015, recent cuts to federal funding are projected to deplete long-term care facility resources as the number of older adults increases, according to the Washington Health Care Association.

“Federal Medicaid reductions … create additional strain on our health care system overall, including long-term care and increase the risk of renewed skilled nursing facility closures,” said Lauri St. Ours of the state health care association.

Funding cuts

Before the pandemic, inadequate Medicaid funding caused an alarming number of skilled nursing facility closures in Washington, St. Ours said.

The state Legislature adopted Medicaid reimbursement rate increases for long-term care providers after the pandemic to better match rising labor costs. These annual reimbursement rate updates slowed closures of skilled nursing facilities across the state in recent years, according to a statement from Washington Health Care Association CEO Carma Matti-Jackson.

“While the Legislature funded a necessary rate update for 2026, it will only fund Medicaid support with the cost of providing care in 2024 — this means that our state is again lagging behind rapidly rising expenses,” St. Ours said.

The decline in Medicaid coverage and reimbursements creates a “double-crisis” of more people needing care in a nursing home combined with fewer nursing home beds, according to the news release from Cantwell.

Of the 68 Washington nursing homes surveyed by Cantwell’s office, 98.5 percent would cut services if Medicaid were cut by 5 percent or more, and 65 percent would consider closing. On average, Washington nursing homes receive 52.3 percent of their revenue from Medicaid, according to Cantwell’s survey.

More than 105,000 Washingtonians depend on Medicaid for long-term care, and the program covers 3 in 5 nursing home residents and 3 in 8 people with disabilities.

At Vancouver Speciality and Rehabilitation, where Kretzschmar works, 63 percent of patients are on Medicaid.

“If we lose billions in federal Medicaid funding over the next decade this is projected to cause us widespread coverage losses and significant instability to my world of hospitals, clinics and nursing homes,” Kretzschmar said.

Dramatic growth

No new nursing homes have opened in Clark County since 2011. Nursing homes are not an attractive investment, Kretzschmar said.

Despite the lack of facility growth, the senior population continues to rise exponentially.

Of the eight skilled nursing facilities in the county, most were built over 20 years ago. In that time, the 65-and-older population has grown by 85 percent from 2010 to 2022, according to the Washington Office of Financial Management.

“The need in our state for assisted living and skilled nursing is already growing dramatically. Today, 16 percent of Washingtonians are 65 or older. By 2050, this population will double. The number of residents who will be 85 or older will increase even faster, quadrupling by 2050 and equaling the entire population today of Clark County,” St. Ours said.

Kretzschmar continues to see more older adults looking for care at her facility but can’t afford it. A room at Vancouver Speciality and Rehabilitation costs $20,000 a month out of pocket, which most residents seeking beds can’t afford, Kretzschmar said.

“I have seen more and more disenfranchised seniors with a lack of resources, and the people who are falling through the cracks are middle-class workers who have been putting money into Medicaid their whole lives,” Kretzschmar said.

Washingtonians contribute 0.58 percent of their paycheck until retirement to the public, long-term care insurance program Washington Cares Fund. Through the program, retirees receive up to a $36,500 annual benefit, which would cover only a few months of private pay at most skilled nursing facilities in the county. To combat sticker shock on care prices, Kretzschmar believes that aging adults should talk with their families about the cost of care before long-term care is needed.