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(posted: 3.15.2019)

Support HB 2048/PSSB 5836

We ask that funding for HB 2048/PSSB 5836 be included in the budget.

This is just one story of many here in Washington State.  Received an inquiry for admission today from Skagit Valley Hospital.   Let’s call him Mr. Brown.  Mr. Brown is a 72 year old male with history of bilateral lower extremity ulcerations, MRSA(drug resistant infection) and hypertension presenting with severe chronic worsening lower extremity wounds.  He was being seen by the Providence hospital wound clinic but was unable to participate in outpatient wound treatments due to loss of transportation and living situation.  He denies use of tobacco, alcohol or drugs.  Mr. Brown and his brother have no home but had been living in hotels.  Patient currently has no place to live.  Mr. Brown’s treatment plan would include daily wound dressing changes by our Registered Nurses.  He would receive daily assessment and intervention from our interdisciplinary team which includes our medical doctor, social worker, occupational therapist, physical therapist, registered dietician, registered nurse, licensed practical nurse and certified nursing assistants.  He would also be seen by a certified wound nurse.  Mr. Brown has Medicare A and B and is a veteran.  He would most probably need to stay longterm with us after his condition was stabilized with Medicaid being his long term payer after he applied for nursing home Medicaid benefit.

We were not able to accept him because we do not have an open Medicaid bed.  A few months ago we were forced to close a unit due to our inability to hire enough RN and LPNs to staff the med cart 24/7.   Our capacity went from 160 bed to 145 beds.  We will forced to continue to shed Medicaid beds if reimbursement continues to fall far short of the cost of care.  Listed below are the “business” reasons we, and every nursing home in Washington State, are increasingly unable to care for our community members who require Medicaid long term care.

  • Eleven nursing homes have closed since 2017. Three of these were for sale without a buyer.  Failure to rebase rates is a major contributing factor.
  • Washington surveyors write three times more IJ and G citations than the United States median. And about twice as many citations in total than the national median.  With IJ and G citations comes “Stop Placement” which cost anywhere from $500,000 to $1,500,000 in lost revenue.
  • Now IJ citations come with daily fines of up to $22,000/day for every day of non compliance.
  • The Medicaid department of DSHS is denying Medicaid benefits for people who have gifted assets up to 5 years before applying for nursing home residents. The nursing home can not discharge this resident who has been denied benefits because there is no “safe place” that will take a resident who requires skilled nursing.  No nursing home will accept a resident who has no money to pay for care and no Medicaid benefit to help cover the cost of care. He did not plan to get sick and require nursing home care.  We admitted a gentlemen who, while healthy and living alone on his property, gave property away.  We now have to care for him for almost three years without any reimbursement.  Or $290,000 worth of free care.  The family had agreed to sell the property to cover the cost of his care until an Adult Protective Services investigator told the family we could not discharge him.
  • The average price per bed for a nursing home in the nation is around $100,000. Closed nursing homes in Washington are being sold for the value of the building and land.  There is no value in owning a license to operate a nursing home.
  • Providers suffered over $147,000,000 in losses serving Medicaid clients.
  • Washington’s mandatory staffing requirements are among the highest in the nation. With no reimbursement for the higher staffing requirements.
  • Washington skilled nursing facility costs on average about $278/day. However, the current Medicaid program reimburses on average $217/day*.
  • Josephine has reduced bed capacity by 15 beds. We were licensed for 160.  Now capacity is 145.  We are often full at 145 and are forced to turn down admissions from community members who are in the hospital.  These residents are forced to go to other nursing homes outside of our community.  Many other nursing homes have reduced bed capacity.
  • Hospitals report difficulty in placing patients in nursing homes.
  • Since 2017 our NAC wages are up 30%. RN/LPN wages are up 10%.  All other wages are up 4-6%.
  • Percentage of Medicaid Direct Care Costs related to wages and benefits is 90%. Or 90 cents of every dollar of direct care cost.
  • We closed a unit because we cannot increase wages anymore and we cannot hire enough RN and LPNs to staff the unit 24/7.
  • Every year from 2008 to 2017 Josephine has provided over $1,000,000 of uncompensated Medicaid care.  In 2017, our skilled nursing facility lost over $1.6 million dollars on our Medicaid residents.  2018 will be worse.  This was the gap between the Medicaid allowable costs and our Medicaid rate. We cannot sustain these losses and continue to provide quality care.
  • Idaho, our neighbor to the east maintains Medicaid reimbursement that is $45/day higher than Washington State.  Oregon’s Medicaid rate is $123/day higher than Washington State.  If Josephine had an Idaho address the Medicaid reimbursement would be $1.6M higher and $4.5M more if we had an Oregon address.
  • Medicaid reimbursement is not keeping up with the cost of inflation.
  • Current rates fall short of minimum wage increases since 2016 into account – and – they do not take into account the cost of increased competition for competent staff.
  • Current Rates are based upon 2016 costs with no adjustment for inflation.
  • A rebase is not currently scheduled until July 1, 2020.
  • Today, rates lag behind costs by 26 months.
  • Before the next scheduled rebase, rates will lag costs by 42 months, with no inflation adjustment.
  • This BILL implements an annual rebase and a small inflation allowance and will go a long way toward stabilizing the nursing home sector.


*John Hancock’s Cost of Care Survey for skilled nursing facility semi-private room in Washington.


Primary Ways and Means contacts

Senator Barbara Bailey             

Senator Christine Rolfes                          Ways and Means Chair

Senator David Frockt                 


Senate budget contacts

Representative Timm Ormsby 

Representative Eileen Cody     


District 10

Representative Norma Smith  

Representative Dave Paul        

Senator Barbara Bailey



Health and Long Term Care Committee

Annette Cleveland, chair          

Emily Randall, vice chair           

Steve Conway                                                             

Karen Keiser                                

David frockt                                 

Kevin Van DeWege                    

Steve O’Ban ranking                  

Barbara Bailey                            

Randi Becker                               

Ann Rivers                                   


Ways and Means                

Christine Rolfes, chair               

David Frockt, vice chair             

Mark Mullet                                

Andy Billing, capital budget     

Reuven Carlyle                            

Steve Conway                             

Jeannie Darneille                        

Bob Hasegawa                                                        

Sam Hunt                                     

Karen Keiser                                

Jamie Pedersen                           

Guy Palumbo                              

Kevin Van De Wege                   

John Braun, ranking                  

Jim Honeyford, asst. ranking operating 

Randi Becker                               

Ann Rivers                                    

Mark Schoesler                           

Keith Wagoner                           

Judy Warnick                              

Lynda Wilson                              

For the week of February 18-22, 2019

Skilled Nursing Funding

On Monday, LeadingAge Washington testified at a public hearing for SB5836, in front of the Senate Ways & Means committee, along with WHCA and SEIU. This bill provides annual rebasing and a small inflation factor and would represent a significant increase in skilled nursing facility Medicaid rates, as well as improving the rate system so rates more closely align with costs. A huge thanks to Terry Robertson and Jeff Cohen for testifying, as well as to members who shared their thoughts and experience with me via email. The bill needs to move out of committee by March 1.


SB 5931, which is a grant program that will help the nursing instructors with tuition reimbursement for their Doctoral Degree. There is a budget proviso written to fund this program, it’s around five million, and there is hope that it would incentivize people to become nurse educators. You can find the bill here.

SB 5932, which allows for an increase in salary for all community college instructors and allows for nurse educators to be given an additional 20% raise increase during the next collective bargaining period. You can find the bill here.

Both bills passed out of Senate Higher Ed Committee this week and are now awaiting hearing in Ways & Means. Match 1st is fiscal committee cut-off, meaning the bills must be passed by that date to survive.

Assisted Living

On Wednesday Chad Solvie, Jen Drake and Don Hansen from Cascade Park Communities went to Olympia to advocate for increases in assisted living and adult day Medicaid funding. These members met with about 20 legislators and/or their legislative assistants. Many of the meetings targeted members of the House Appropriations and Senate Ways & Means Committees to explain why there must be a larger appropriation than the amount included in the Governor’s proposed budget. Many legislators are worried about the state’s budget this year. When they are deciding what to cut and keep in the budget, it’s important they remember the conversations they’ve had with providers and the impact it has on seniors’ access to quality care.

You can make our voice louder by asking your residents, staff and family members to call their legislators and ask them to support medicaid funding increases. Here is a flyer to post or distribute in your community with step by step information on calling the legislative hotline. Please continue to keep advocating!

Adult Day

Dave Budd from Full Life Care went to Olympia this week to advocate for a 15% increase in Medicaid rates for adult day providers. Dave and the LeadingAge team met with Senator Saldaña, Representative Pettigrew and many others. Many of the Senate Ways & Means Committee members were asked to “champion” the adult day budget proviso request. Other adult day providers are coming to Olympia next week to continue these important asks. The adult day funding request is gaining traction so please keep this positive momentum going and call or email your legislators or join us in Olympia. You can find the issue brief here.

Other Bills

The Long Term Care Trust Act (HB1087) has passed the House. The bill was passed with 63 yea and 33 nay votes. The companion bill, SB 5331, has also been moving forward and it now goes to the Senate floor. To learn more about the LTC Trust Act please see the 2019 fact sheet here.

Thank you,

Alyssa Schnitzius-Director of Senior Living & Community Services

1102 Broadway, Suite 201 | Tacoma, Washington 98402

p: 253.964.8870 | c: 206.948.2279