MARY LOUISE KELLY, HOST:
When older people in the U.S. end up needing long-term care in a nursing home or from a home health aide, most have to pay out of pocket. The cost can be huge. This month Washington became the first state to try to address that problem with a public long-term care benefit funded through a payroll tax. From member station KUOW in Seattle, Eilis O'Neill has more.
EILIS O'NEILL, BYLINE: Every morning, Veronica Tausili uses a lift to swing her mom out of bed.
VERONICA TAUSILI: So this is the Hoyer lift right here. It's my best friend (laughter). Yep. And this is the sling that goes underneath her.
O'NEILL: Tausili's mom has been bedridden for more than three years because of complications from diabetes, a broken femur and cancer.
TAUSILI: I have to go in every morning and undress her, and then I'm going to clean her all up. You've got to lift her up with the Hoyer lift so I can change her sheets.
O'NEILL: Tausili and her mom live in her sister's house about an hour south of Seattle. In 2020, Tausili quit her job as an escrow officer to take care of her mom full time. She cashed out her retirement to pay her bills. Since then, she's rarely had a day off.
TAUSILI: If I'm going to go out, I'm always on a time limit because I've got to make sure I'm back home to change Mom.
O'NEILL: Tausili's mom won't be able to benefit from the state's new long-term care program. You have to pay in for at least three years to get anything out. If the program already existed, it would not cover full-time care for Tausili's mom. But Tausili says she could use it for respite care, or she could have hired an in-home caregiver after she hurt her shoulder in a car crash and couldn't lift her mom.
DAVID GRABOWSKI: Here in the U.S., we're heavily reliant on family caregivers because we don't have a public system in place.
O'NEILL: David Grabowski is a professor at Harvard who researches health care policy. He says paying for long-term care is a challenge for families nationwide. That's because Medicare doesn't cover long-term care. Private long-term care insurance is expensive and usually has caps on benefits. Many don't even qualify for it if they have preexisting conditions. So people have two options - spend down all their savings and go on Medicaid, or turn to family.
GRABOWSKI: Unpaid care is not free. We place this care largely on women and lower-income individuals. Individuals often have to take time off from work to provide this care.
O'NEILL: This problem is only growing as baby boomers age. About 7 in 10 people will need long-term care at some point. With Washington's new payroll tax, the state automatically takes money from most people's paychecks each month. Then, if they need help with basic tasks of daily living, they can apply for a lifetime benefit of up to $36,500, a number that will grow with inflation.
CATHY MACCAUL: The future is a little scary, but it'll be in the back of my brain that at least I have that benefit.
O'NEILL: Cathy MacCaul is the advocacy director at AARP Washington and a proponent of the new program. MacCaul says people could use the money to pay for in-home care, respite care. Or...
MACCAUL: A lot of people just need a ramp built on their house in order to still live at home. Or maybe it's just meal delivery.
O'NEILL: Those opposed to the new program include some of the state's Republican lawmakers, who say the private insurance market offered better options.
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JOHN BRAUN: This is a woefully inadequate program.
O'NEILL: State Senator John Braun gave a press conference shortly after the payroll tax went into effect. He said the new program doesn't provide enough money to pay the full cost of long-term care. And another tax is bad for Washingtonians.
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BRAUN: It's going to be one more step that makes Washington state unaffordable for a whole group of workers.
O'NEILL: Supporters of the tax agree it isn't enough money to pay for years of care. They see it as a stopgap during short-term crises or a way to help people stay in their homes for longer. Meanwhile, other states are moving in the same direction. California is considering a tax similar to Washington's, and several others are studying options. For NPR News, I'm Eilis O'Neill in the Seattle area.
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