Recommendations
The following recommendations are for the SEIU 775 as it sets strategies regarding the implementation of the Washington Cares Fund and the rule-making process. While we frame these recommendations in the context of Washington State, we believe that they can provide guidance to other states across the country as they implement similar legislation.
Advocate for consumer protections.
Beneficiaries of the fund are going to have flexibility with regard to how they spend their allocation. They will also have limited in-person support as DSHS prepares to develop a digital-first strategy for outreach, education, and navigation. They will not necessarily have caseworkers like Medicaid recipients, and some may not have a support system to rely on in terms of family and friends. Safeguards need to be developed during the rule-making process to curb possibilities for profit-driven actors to take advantage of Fund beneficiaries. Applying similar training and standards requirements that exist for Medicaid providers to the Washington Cares Fund is one possible safeguard that should be considered during rulemaking.
Ensure that beneficiaries are positioned for a smooth transition to Medicaid.
Many beneficiaries of the Washington Cares Fund will eventually transition to Medicaid, and that process should be smooth for them as well as for their doctors and caregivers. Those with experience managing long-term care service delivery are experts in how to best make this happen. Listen to what they have to say and consider supporting their recommendations.
In outreach, use language to meet people where they are—particularly in communities that heavily rely on informal care.
In interviews, we asked participants their perspective on the term long-term care versus long-term services and supports. “[My community] would take support and relief,” said an interviewee from a small, rural community where informal caretaking is tradition. “‘Services and support’ language is important in these communities,” she emphasized.
Language choices made a big difference in whether she thought her community members would accept professional help from someone who is not part of the family. For some people, there’s no stigma attached to paying a professional for care. But for this particular interviewee and for those in her community, hiring a caregiver might mean failing at one’s familial duties.
In another circumstance, a community-based advocate who supports African-American seniors said that the individuals seeking support through her organization choose not to use government services. These are individuals who lived through the Great Depression and worked in jobs, often paying a low wage, in order to purchase a home that they could pass along to their children. For them, relying on public programs—like Medicaid—means giving up everything that they have worked hard to build (because the income restrictions for eligibility are so low), making Medicaid signup not an option.
“They don’t trust the state; [and when they think of services and supports], they see it as the state coming in and taking their house.”
This mindset has continued in the generations that have followed, and that generation could benefit immensely from the Washington Cares Fund since, unlike Medicaid, it comes without income restrictions. However, to change their perspective on using public programs, outreach strategies will need to take into consideration their real mistrust in government, and this may mean working in partnership with CBOs that represent them.
The fund may create an opportunity to change the way that people think about long-term care, particularly in communities that are used to caregiving as unpaid labor by family members. That’s a big deal. However, Washingtonians come from diverse cultural backgrounds, and in order to change perspectives, messaging should meet beneficiaries where they are.
Offer a simple process for those beneficiaries who will have to opt-in.
Gig workers, freelancers, and entrepreneurs will not have employers to automatically facilitate their participation in the fund. The gig worker, freelancer, and entrepreneur interviewed for this report stated that they would choose to opt-in to the fund. This leaves the team to speculate that many of these workers will choose to opt-in as they often have unstable and low wages and will commonly not have access to long-term care resources otherwise. It’s also likely that their lives might have many moving parts that make administrative work hard to maintain. The fund’s website has set up a page for workers who will need to opt-in. To bolster participation in the fund and equitable access to the benefit, Washington should be proactive in spreading awareness of the benefit, and simplifying the process to opt-in and contribute. Also, since employers from tribal nations have different concerns than those regulated by the state, Washington should allocate resources to ensure that employers and employees from tribal nations have the information that they need to make decisions about participating in the fund.
Make the program’s digital analytics open to the public.
The fund’s commission will be responsible for reporting on program participation and related demographics. Given that DSHS plans to focus on developing web-based services, the data analytics of the fund’s website should be used as an accountability and tracking tool to evaluate equity and accessibility to the fund benefits.
Fund commissioners should have access to these analytics to help them gather data for their reporting responsibilities. Even better, data analytics for the fund’s website should be publicly available so that communities not represented by the commission might still have an opportunity to participate in continuously increasing equitable delivery of fund benefits. Many CBOs will inevitably support the Fund by providing education, outreach, and navigation services. Making these data available to everyone would help CBOs and others direct their efforts. The Fund might even consider offering monthly presentations to go over insights from the site’s analytics as a way to involve and inform CBOs of who the fund is reaching and where there are gaps in service.
Open data practices are becoming increasingly mainstream within government due to the value that they provide in increasing civic participation and reducing administrative burdens related to public record requests. See the federal government’s Digital Analytics Program to get a sense of how others in government are opening up their website analytics to improve government service delivery.
Clearly state what services are covered and what are not.
As mentioned above, we have discussed the need for consumer protections—it’s critical that services provided by the fund focus on the safety and protection of beneficiaries. Once DSHS has set which services it will fund, those services will need to be made clear to consumers.
Long-term care, in general, is not a well understood term—people have varying understanding of the services that it entails. To manage beneficiary expectations, DSHS should clearly state the types of services and supports that the fund. Also, DSHS should be concise about the services that the fund will not cover—and why they’re not covered. It is also an opportunity for officials to identify services that properly protect beneficiaries as they age or face unexpected health crises. Making this distinction also will reinforce beneficiaries' understanding of what they are responsible for securing on their own.