Ninety percent of Washingtonians don’t have any kind of private long-term care insurance, but about 70% of people over age 65 are going to need it.  Washington’s long-term care system is going to be further impacted by the “Age Wave” that has the population of those 85 and older doubling by 2050. That’s going to mean we have a lot of people who need care and and might not know how they’ll pay for it.

Cathleen MacCaul, advocacy director for AARP of Washington, who represents the organization’s 900,000 Washington members, says finding effective and innovative solutions to the problem of long-term care coverage has been a top priority for AARP for decades and one she has worked on for over seven years.

So what’s the solution? To better understand the options, let’s first look at the problem in more detail.

Who needs care?

Most people will need some type of long-term care as they age. MacCaul says it’s especially important for people with dementia or chronic illnesses like MS, cancer, HIV, diabetes, heart conditions and genetic diseases. Even if a family member provides the help, then that caregiver needs support because the work can be exhausting and is often 24 hours a day, 7 days a week.

“What’s great about community-based services is that more individuals can stay in their homes with modest levels of care,” MacCaul says. “So an aide coming in four or five hours a week to help with bathing, meal preparation, medication and blood pressure checks or laundry can really help the person stay at home longer.”

What does it cost?

MacCaul had a family member with dementia who lived in a memory care facility for the last 3-4 months of her life. The facility cost $7,000 per month.

“It’s expensive, and it took a financial toll on our family,” she says. “It adds up quickly, and if you’re on a fixed income, it could be impossible to pay.”   

However, paying out of pocket isn’t the only solution. For people who pay into a WA Cares Fund, their families have a budget of $36,500 (which increases with inflation) that can be used to hire a home care aide even if that person is a family member or for care in a facility.   

“People can use that benefit for 12 to 18 months of in-home care,” MacCaul says.

Insurance options

Many people are confused about what’s covered with the long-term disability plan that is offered by their employer or Medicare. According to MacCaul, disability ends when you leave that employer and Medicare doesn’t pay for long-term care.

“It’s important to get the facts,” MacCaul says

There are a variety of options available, including private long-term care insurance and state programs like the WA Cares Fund.

The cost of private long-term care insurance is based on the level of services covered and the policy buyer’s age. Younger, relatively healthy people at low risk of needing long-term care will see the lowest premium costs. Many insurers charge women significantly higher rates than they charge men for equivalent coverage. Costs can also go up for those who are older, have health problems, or want to add more benefits.


There can be some challenges with using private insurance for long-term care coverage.

  1. Pre-existing conditions may make you ineligible.
  2. You will have to pay the premium well beyond your working years and into retirement.
  3. Plans can be canceled if you miss a payment, change your job or have a change in health status.

The WA Cares Fund offers similar benefits, but you only pay while you’re working, not after you retire. Beginning January 2025, each person eligible to receive the benefit can access services and supports costing up to $36,500. WA Cares benefits are funded by worker premiums. To qualify for benefits from the WA Cares Fund, you must have worked and contributed to the fund for:

  • At least 10 years at any point in your life without a break of five or more years within those 10 years, or
  • Three of the last six years at the time you apply for the benefit, and
  • A minimum of 500 hours per year during those years.

“This program is the third pillar of retirement security after social security and Medicare,” says Benjamin Veghte, the director of the WA Cares Fund. “Ten other countries do this already. It’s a proven concept. It’s just like Medicare, except it’s for long-term care, which isn’t covered by Medicare.”

Veghte points out that when you’re paying for private insurance, you’re paying for their salaries, underwriting expenses and profits. The WA Cares Fund doesn’t have these high overhead costs and its goal is to provide as much coverage as possible for Washington workers.

MacCaul has a friend who’s a 45-year-old man with HIV. He’s never been able to get long-term care insurance. When she saw him recently he thanked her for her work. He was relieved to be able to have some kind of coverage that would be there for him when he needs it.   

Washingtonians for a Responsible Future is a broad-based coalition of aging and disability advocates, businesses, long-term care providers, labor, consumer rights organizations and families working to start this important conversation.