Bush administration wants in-home care for more elderly, disabled

[No Mandate Here.]

http://story.news.yahoo.com/news?tmpl=story&cid=2270&ncid=2270&e=2&u=/krwashbureau/20050225/ts_krwashbureau/_bc_medicaid_wa

By Tony Pugh, Knight Ridder Newspapers

WASHINGTON - The Bush administration believes it can improve services for Medicaid beneficiaries and help the program's shaky bottom line by caring for more elderly and disabled patients in their homes or through community-based programs.

Experts say doing so is much cheaper than institutional care and allows some of Medicaid's most fragile patients to remain more self-sufficient.

"Anything that keeps a person out of a nursing home preserves their ability to maintain their dignity and their independence," said Dr. David Bean, a geriatric psychiatrist in Sioux Falls, S.D.

President Bush (news - web sites)'s 2006 budget proposal seeks $500 million over five years to move some of the disabled out of institutions and into these community programs. For patients who make the switch, the federal government would pay the entire cost of care in the first year and then split the cost with states - anywhere from 50 to 70 percent - in subsequent years.

lots more...

He really DOES want to return to the days of the old robber barons. You were either rich, or you were a serf.

[Kadie]

1. Well, first of all they need to stop

trying to cut the wages of the home health care workers. That is what arnie is doing here in CA, and people are facing the fact that they will have to put their loved ones into homes because they can't find people to help take care of them.

[Warpy]

19. Second, they've got to stop cutting reimbursememt to agencies

which they've been doing forever.

If they keep paying starvation wages to home care aids and overworking the nurses and other staff with burdensome paperwork, they can whistle for this cheaper solution, cause it aint gonna happen.

[KamaAina]

2. Here's the 'gotcha'

For patients who make the switch, the federal government would pay the entire cost of care in the first year and then split the cost with states - anywhere from 50 to 70 percent - in subsequent years.

Previous versions of this proposal shifted all of the burden to states in "subsequent years". I'll need to find out if the 50-70% figure is new or if the reporter missed something.

In principle, community-based care is something the disability community wants badly. We view nursing homes and other institutions as little beter than prisons: soulless, dangerous, inhuman places. Leave it to Bush** to screw it up by hiding the cost transfer and leaving the states stuck with the tab (followed quickly by a collapse of care).

[pop goes the weasel]

6. you are right about the cost

He knows full well that the states have all slashed Medicaid funding.

[KamaAina]

7. I've been studying this for some time

deep down, I just KNEW that if Bush** was behind it, it couldn't possibly be good in the long run. And there it is: one year of care under a splashy, well-publicized demonstration program -- and after that, it's up to the whims and vagaries of states and their budget processes.

[Sugarbleus]

25. Good Catch KamaAina....I was about to jump in and say

WOW, finally! (Although who can ever trust what the Bushenator says.)

So, in your estimation, this is a no win situation then? I ask because, as you pointed out, there are so many people in nursing facilites and other "institutions" that are just revolted to be there.

These places take most if not all of their feeble income in return for the worst care imaginable--if you are low income that is. We have a friend that wants out so badly; he has progressive MS. He'd LOVE to be able to live in a single private apartment with nursing help coming to him.

I fight with HUD over my right to be a live-in aide caregiver for disabled ex husband/S.O. so he doesn't end up in one of those places also. I've used the same facts as in the article: that it is CHEAPER to care for him at home than to send him to one of those "facilities"...where he'd soon die of a broken spirit if nothing else.

[KamaAina]

28. It's only a no-win situation the way Bush** is doing it

Think of it as "No Disabled Person Left Behind": a clever way to sabotage the system while proclaiming a sweeping reform.

Your local Center for Independent Living may be willing to help transition your friend out of the home. In a rare moment of lucidity, the Extreme Court came down with the "Olmstead decision", which states that people with disabilities have the civil right to live in the least segregated setting possible.

Some Centers are more willing to tackle this admnittedly difficult task than others. You can find the one in your area at:

http://www.ilru.org/jump1.htm

[Spinzonner]

3. It's not a bad idea

the care in institutions can leave much to be desired. (Personal experience). Who goes home and who stays needs to be carefully evaluated both in terms of the patient and the capabilities of the caregiver.

But this has to include paying the family members - when necessary - who will have to stay home and care for them and providing respite services, etc. and in-home services from visiting nurses, etc. etc.

Of course, with Shrub and his cohorts, it's more likely to turn into the something akin to the dumping of mental patients out of institutions without the appropriate and necessary community resources being provided - More Social Darwinism.

[pop goes the weasel]

4. what are you talking about?

Those of us in the disability community have been pleading for years for the federal government to change its funding of health care so that people forced into nursing homes could live either independently or with family. I would like to think that Bush is serious about this, but I doubt he really intends to follow through.

[aquart]

20. Sorry. He won't fund it.

He never funds any social program unless it's a religious sham giveaway.

[kevinmc]

5. Bush World Code .........

.....for go home and die.

[Tansy_Gold]

27. And while you're dying, make your relatives' lives

miserable.

Do I sound selfish? maybe. But I've seen what happens when there is no money to care for an aging, ill, dependent person. They become the very thing they themselves don't want to be: a burden on their children.

If there is truly "community" assistance to help people remain reasonably independent and give their caregivers respite and aid, that's fine. But I see too much threat of "the good ol' days" in anything booooosh proposes. The elderly and the infirm will be dumped on their children and grandchildren, who will have to give up their time, their independence, their jobs, their homes, while the wealthy just pay someone to do it for them.

There is no "dignity" for anyone in this.

I hate these booooshies more and more and more every damn day.

[LisaM]

8. Yes, you're probably right... it doesn't SOUND like a bad idea

but I'm sure that there are many hidden problems with it.

[Tempest]

9. Elderly abuse a major problem in the U.S.

And the biggest offenders are in-home care providers and family members.

More proof Bush hates old people.

[cornermouse]

10. It won't happen without financial and emotional support

and that is exactly what the federal government and the states are cutting.

Just Bush looking for more freebies.

[Malva Zebrina]

11. Of course

private nursing homes make no money off of Medicaid patients. They only tie up a bed,and are required to do so, btw,at least one bed must be reserved and held if that Medicaid patient needs to be hospitalized, when it could be given to one whose insurance would pay more and it is becoming that way for even Medicare recipients.

Believe me, those in nursing homes with a chronic disabled condition can in no way be considered self sufficient with an aide visiting for two hours a day to wash and bathe them , do light housework such as washing dishes, and then take off. Not that these workers do not care,but these are the rules,. Who will do the necessary heavy cleaning? Home health Aides are not required to wash windows, or do any heavy cleaning.

What a plight. Do not get elderly or disabled, be poor without a family that cares or is involved, or you are doomed to be labeled a blight on the state and subject to it's ways and under a Bush that is that you are discarded as nothing more than an impediment to the bottom line of profit for nursing homes.

[teryang]

12. What a joke

$500,000,000? This won't even dent the number of people going into such long term care facilities. Reversing the numbers isn't even a remote possibility with such a paltry sum.

[MichiganVote]

13. Another faithless based pie in the sky idea

Ever take a good look at child care in this country? Splintered, largely unmonitored, expensive, insufficiently regulated...

So, send the problems to the states, include pocket change for a few medicare payments and guess what? We'll own it. This is just another example of Washintonian piss poor planning.

[Disturbed]

14. The Bush Junta are Fascist liars

This new plan is another con job.

[fairfaxvadem]

15. They've never gotten anything right, and won't with this either.

I've seen it both ways. When I was in high school, an elderly great-aunt with increasing dementia came to live with us. My parents took her in because that's what you did for family, and there were few resources in our area in the late 1970s. But the toll it took on my folks' marriage was evident. We finally were able to get a spot for her in a nursing home over an hour away.

Now, it's my mom's turn. She has Alzheimer's. My siblings and I all knew that keeping her in her own home was no option. In fact, it was the sale of that house that gave us the financial wherewithall to have her in a private facility. The care isn't perfect. It never will be. And we do a lot for her still despite the assisted living, and that's fine.

But we always wonder, what do people do who don't have the resources? We know we are extremely lucky, compared to a lot of other families.

We'd all like to grow old at home. I know my mom would have. But who lives close to all of their family for support? Not many of us anymore. And you can't do it alone. The toll is too great.

[Name removed]

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[Tansy_Gold]

29. You're absolutely correct, fairfaxvadem

I saw it in my family, too. My grandparents cared for aged and aging relatives literally from the day they were married in 1923 until my grandfather's older sister died in 1968. At her funeral, my grandmother wept, because for the first time in 45 years, she and my grandfather would be alone in their own home.

My husband's aunt is currently in a nursing home. Mentally, she is sharp but has physical limitations. Her daughter was caring for her (full time, unpaid), until the "reverse mortgage" on the aunt's home ran out. Forced to take a minimum wage job to pay for her own housing, the cousin can no longer take care of her mother, so she's in a nursing home. The home takes her pension, her social security, and any other 'benefits' she accrued during a lifetime of gainful employment. She will die a pauper.

But this is the greatest country in the world, right?

[Mandate My Ass]

17. The crux of the problem is always at the bottom of the article

"Kenneth Thorpe, chairman of the health policy management department at Emory University in Atlanta, agreed. "If you allow states a tremendous amount of experimentation with these home- and community-based programs, you have to have some examination that the services being delivered are of high quality and clinically effective."

"More than 70 percent of the state community-based programs reviewed by the federal Centers for Medicare and Medicaid Services had one or more patient care problems, according to a 2003 report by the Government Accountability Office, the investigative arm of Congress. The most common were failure to provide necessary patient services, poor case management and inadequate patient care plans developed by caregivers.

The report also found that the Centers for Medicare and Medicaid Services doesn't hold the states accountable for submitting annual community program reports on time.....

States have offered community-care programs for nursing home-eligible Medicaid patients since the early 1980s. Funding problems have limited enrollment, however, and waiting lists are common and likely to increase as the nation's elderly population grows.

</snip>

So for a patient who requires 24/7 nursing care, what happens to them while they're on the waiting list?

[eleny]

18. They want to return to the way it was but with a twist

I worked in social services from '71 to '99. I remember when people had the choice to go into a nursing home or get 24 hour care (or less) at home paid for by Medicaid. I did the evaluations to determine how much and what kind of care was needed. In theory this is wonderful when it's managed and funded adequately. How the Bush Administration may fuck it up is another story.

What would help people *not* speed towards a nursing home situation in the first place would be more home health care like what Medicare allowed until recently. Before my folks moved here to live with us, they were in another state and had home health 3 times a week. The aid cleaned house which was pretty minimal, helped my folks with their showers to be sure they were safe from an accident and the aid did the shopping. My parents got a total of 6 hours of care per week. Without it they would have had to go into nursing homes. Weigh the difference in costs. Amazing, huh? Couple of hundred a month vs thousands.

Then they came to live with us in their last years. Before I retired, we hired home health so they could have showers at a convenient time for them. After my retirement I only continued minimal home health because they loved the care giver and she was also a source of company for chit chat.

Between home health care, some visiting nurse and perhaps community outreach like a visit from a church member or a daily phone call from that type of volunteer srevices - a lot of lonliness and unnecessary accidents would delay the need for major, daily care. And that's my not so humble opinion.

[fairfaxvadem]

24. I completely agree that in many cases it can be delayed

But with just about everything, it depends on if that sort of reliable, qualified assistance is available. And of course, for any type of elder care to be successful, whether it be in home care or at an assisted living facility, it requires that at least one close member of the family, preferable more if possible, be constantly vigilant and an active advocate for their parent or loved one.

From my own personal observations and experience, it's those suffering from dementia and advanced Alzheimer's that the inhome care tends to be more difficult, even with hired professionals. My mom's two brothers are both physically in poor shape, but due to the fact that they still have their mental faculties, staying at home has been a viable option. My mom would have needed 24-hour professional care some time ago if we'd wanted to keep her at home. One benefit of the community living for someone in my mom's present condition is that she does get a lot of daily stimulation and she gets taken out by one of us 4 to 5 days a week, so at least we can keep her routine varied. She sure enjoys her car rides.

[eleny]

26. I agree with you completely

It's some of the physical handicaps that can be managed well with some home health assistance. My mother was in a wheelchair from a stroke and only walked a little bit when necessary. Mom and dad had no family nearby when they lived in Florida. They lived very well from a safety point of view. Their minds were clear. It would have been a shame if they had to go into a nursing home. They owned their small home. But the sale of it would have been expended quickly and they would have been on Medicaid in about one year. Home health kept them on their own with minimal Medicare contribution. Then it went away and I begged them to come up here. It was even better having them here.

I would like to see some sort of assisted living be paid for by Medicare or the home health. I'd gladly pay more taxes. Maybe I'm nuts. But I think that in the long run, family members, kowing that the disabled in the family are cared for, would be more productive at work. They would worry less, take less days off etc etc. You know what I mean having the experience. It's worth it to me knowing my country values all its citizens.

[Megahurtz]

21. Bush just wants to get the elderly and the disabled out of his hair

and dump them on their relatives, who, in many cases are unable to take care of them, financially and emotionally.

There really aren't much for community programs, especially here in California where good old Arnie is cutting everything.

So what's left? The relatives. But what if there are no relatives or the relatives cannot take them in???

Bushitler doesn't care whatsoever. He just thinks he has to sugar-coat this issue because I'm sure he's been challenged on it regarding Social Security.

The elderly (a large number of them) and the disabled will be dumped out on the streets if ShitHead gets his way with privatizing Social Security.

For example, who of the disabled can save up for a private account when they are living off of disability pay???

Bush just doesn't care, he just wishes that they would all go away.

He's just lying and deceiving the American public, again.:argh:

[Bozvotros]

22. Lets do the math...

Cheapest nursing home runs about 100 bucks a day, not counting medications. Figure minimum care at about 40,000 bucks a year

One hundred million a year divided by 40,000 bucks a year = 2500 people.

Divide that by 50 states and you have 50 people a year moved into their home for each state. Golly that is soooo generous.

Also figure that Bush will force deeper cuts in Medicaid to cover his wars and tax cuts and this will force more cuts to nursing homes who will begin cutting staff and services and salaries so that things won't be quite so cushy for those not lucky enough to win the one year at home lottery...

You know someone in charge is staying up late trying to think of how to market tasteful religious-themed euthenasia parlors to their fundamentalist fascist friends.

[Sugarbleus]

32. "euthenasia parlors"

SOLENT GREEN..........:scared:

[Name removed]

23. Deleted message

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[LynnTheDem]

30. Reality: bush wants to close down nursing homes

[0007]

31. More smoke and mirrors

The last sentence sez it all; "The question is are we willing to put the time, money and resources into the regulation of these programs?" Harris said. "It's just something that needs an awful lot of study."

The Senior Companion Program in Midland Texas pays the so-called volunteers $2.65 an hour to assist with helping to keep folks out of the nursing home. There is a lot of propaganda and hype to pump up the so-called volunteers.

[Sugarbleus]

33. I've been working for the In-Home Supportive Services

in California since 1985. In the last few years, this district office, with the Union SEIU's help, gained us a raise AND benefits. My rate is $9.50 per hour.........but of course I only get 41 hours a month.

I can tell you that I've worked MY ASS OFF in this job. I've done things that they don't pay me to do. I rarely get any time to myself either.

I am a Live-in caregiver--I no longer work outside the home; however the HUD/HOUSING is now arguing back and forth with us about whether or not physically handicapped ex hubby/S.O./client is entitled to such assistance. (??????????????????)--we've been doing it all these years!

The last letter I got from that bunghole dept said we had a choice: Either move to a two bedroom and I can then continue to be his aide OR stay in this tiny three bedroom WITH MY GRANDSON here and give up my status. See, Bush started cutting affordable and subsidized housing for the poorer and lower income folks more than a year ago which just complicates things even further.

Schwartzengrabit wants to cut caregiver wages and/or cut us out altogether, yet we now learn that Bush WANTS to have care givers do the work/empty the nursing facilities....THEN in some cases, a person's dwelling factors into this scenario too (as in our case):crazy:

It's six of one, half dozen of the other. The right hand doesn't know what the left hand is doing. If they can't convince us, they confuss us. Whadda country!