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Feds Have to Bribe States to Help Keep Disabled and Elderly People at Home

Feds Have to Bribe States to Help Keep Disabled and Elderly People at Home

If you’re a nondisabled adult, chances are that you may never have given a thought to the security of your right to live in your own community, among people you know, in a home where you feel comfortable. While not spelled out in the Constitution, such a right seems natural, almost native, to the ethos of the United States. But for millions of Americans, it’s not: care needs routinely force disabled people and older adults into institutions including nursing homes, long-term care facilities and assisted living facilities, often over their protests.

Imagine being torn from your home and community: now think about the fact that even people who plan ahead for aging and retirement sometimes end up having to rely on Medicare and Medicaid for support as medical bills outstrip their resources, and thus live out their days in nursing homes.

In a 1999 case, Olmstead v. L.C., the Supreme Court affirmed the right to live in community-based placements when it didn’t create an undue burden, as an extension of the Americans with Disabilities Act (ADA), passed in 1990. The case has since been used in states across the Union to defend the right to live in the community: either at home with assistance from care providers, or in group housing that’s positioned in small, community-based settings. Several studies, including those by organizations like the AARP, show that not only is community-based living a human right, it’s also more cost-efficient and can result in better outcomes — especially given the abuse in long-term care facilities.

Yet, even with legal support, disability rights activism and evidence-based knowledge indicating that community-based living is preferable in almost all cases to institutionalization, many states have an alarmingly high number of institutionalized residents. This includes not just adults, but disabled children who need advanced medical care, many of whom are held in adult facilities because long-term care facilities for children are extremely rare. This is an issue of concern to the Department of Justice, disability rights organizations and advocacy groups focused on improving access to quality health care and a good quality of life.

Consequently, the federal government is offering a bribe, of sorts (it’s really an incentive program) to states to promote a higher percentage of community-based living placements. Through $3 billion in funding from the Affordable Care Act, participating states receive additional funding for at-home care and support services through 2015, as a way of effectively encouraging them to comply with already existing laws and court precedent. In return for the extra funding, they’re required to streamline the process of helping people access care in non-nursing home settings.

In New Hampshire, a sort of model state, the state has succeeded in transitioning nearly 99% of developmentally disabled adults into at-home care, showing that it is possible to turn away from an institutionalization-based approach to providing care and support services.

One concern cited by advocates working to improve these statistics even more, however, is the nursing home industry. Nursing homes are already nervous about cuts to Medicare and Medicaid funding aimed at keeping people out of institutions, and many do not relish the thought of government-sponsored endeavors to promote even more community-based settings. Thanks to a considerable lobbying body, the industry could wield considerable clout when it comes to actually rolling out community-based living measures.

One argument that could be raised, of course, is the huge numbers of jobs the industry provides. Were nursing homes forced to shutter, people with specialized skills would find themselves out of work. Or would they? With a rise in community-based care, there would be an increased demand for orderlies, medical assistants, and nurses, particularly those capable of providing skilled nursing care at home. Many former nursing home employees might be able to transition to at-home care with minimal disruption.

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Photo credit: National Assembly for Wales.

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81 comments

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7:11AM PDT on Apr 6, 2014

The HUD and Eden Housing keep raising the rent which forces poor people to be homeless.

7:04AM PST on Jan 30, 2014

The lucky ones will die before having to enter nursing care facilities and/or engage less than caring at-home assistance ... the rest will become just medical waste or room and bed numbers. Overall, humankind, in my opinion, is at an all-time low.

Societies used to cherish the olders of the family and hold them in high esteem (maybe that's part of the problem, no "family" just a me-first generation). Can't wait until they peak and start on their own road to experience the limits of aging. Only then will the problems involved hit home ... and well deserved. Too bad so sad.

If you know of someone presently in such a situation, a humane act of kindness such as an occasional phone call or visit can make a huge difference to a confined or forgotten person ... maybe think about it?



9:33PM PST on Jan 29, 2014

Thank-you for this interesting article. ...and ....there is another good facet of The ACA.!!!

7:28PM PST on Jan 29, 2014

...

I tried to make him not feel bad. I said, everyone has accidents sometime or another, everyone needs help sometime or another. I tried to make him still feel dignified.

Even though it wasn't my job to interact with him at all.

Can you imagine if I'd just said "it's not my job" like so many do, and he had to sit there in his perceived shame, or inch himself back to his ward, just to have an aide say "not now, can't you see I'm busy!"

But I risked being repremmanded for "interfearing in things that don't concern me, and to go back to the kitchen".

If you have to find a "home", find one with cameras everywhere.

7:27PM PST on Jan 29, 2014

THERE SHOULD BE MASSIVE NURSING HOME AND ASSISTED LIVING REFORMS. IN FACT, SOME PLACES HAVE TOO MANY PEOPLE AND TOO LITTLE STAFF...AND IF THEY HAVE STAFF...SOME PLACES DO NOT MAKE SURE THEY HAVE BETTER STAFF.

7:26PM PST on Jan 29, 2014

....

5. I saw a "victorian" lady who was 102, with a very sharp mind, bright eyes, and refined manner. There are very few are left in the world today with such refinements. Can you even imagine what she saw, and experienced in her life, from one hundred years ago?

6. lady patients begged to have a sandwich or bit of food to have as a night snack.

7. patients begged to have something not on the menu (fish on Friday, Fish on Friday, Fish on Friday, how long would it be until you refused to come to the dining hall on Fridays?

8 there was a 25-30 year old vegetarian in this nursing home among only elders because she was wheelchair bound. There was nothing wrong with her mind. Can you imagine that, the same routine every single day, no peers your age, the same red carpet, same white walls, the same menu. What did she do all day, day after day?

9. people need jobs, why aren't people trained as a personal aide for EACH patient, so the patient won't have to sit in wet pants, sleep at a table, or wait until who knows when, to have help with something. If an aid isn't comfortable with the changing of the pants, then that should be the only task of those that can do that. People in nursing homes should not be multitasking so much that the patients don't get tended when they need something.

I still smile when I remember that quietly flustered old man. I would have loved to have such a sensitive dad. He was such a quiet sweet soul. What men are like that now?

I trie

7:24PM PST on Jan 29, 2014

Believe me, my mom was emotionally and physically abused in a nursing home in this town I live in. I have proof. I went home one night and the next day my mom had a large white 2 x 4 bandage on her arm. When I asked what had happened I was told she had fallen in the bathroom and scraped her arm, another person said she was beating up on herself. This was in the last four weeks of her life. I had complained two times to the then now forever gone nursing home administrator two times. Another time, my mom had told me some woman was coming in her room at night with a cane and had threatened to hit her, so I asked this smart ass young man nurse and sh said the woman could come in my mom's room any time she wanted and I SAID OH NO SHE CANNOT. SO I STAYED MOST OF THE NIGHT FOR TWO NIGHTS AND COMPLAINED TO SOMEONE AND FROM THEN ON MY MOM SAID SHE WAS OK. HOWEVER, SOMEONE DEFINITELY DID ABUSE MY MOM......NEVER FOUND OUT WHO, BUT SOMEONE. THIS TOWN WILL NEVER HEAR THE LAST OF ME, I HAVE SERIOUS GRIEVANCES......ALSO BACK IN 1999 SOME POOR OLD WOMAN WHO WAS AT THE NURSING HOME TOOK A TAXI TO A LOCAL RESTAURANT ON OUR LAGOON AND THAT EVENING SHE WAS FOUND FLOATING FACE DOWN. I WAS TOLD IT WAS BECAUSE SHE DID NOT HAVE ANY FAMILY HERE BUT I AM SURE SHE WAS ALSO SUBJECT TO ABUSE, SINCE SOMEONE IN THE NURSING HOME, A NURSE, SAID MY MOM WAS SPOILED BECAUSE SHE HAD FAMILY COME IN SO OFTEN. THESE YOUNG PEOPLE IN THE WORLD AND BACKGROUND I WILL GET EVEN AT LEGALLY. BELIEVE ME, IF I E

7:24PM PST on Jan 29, 2014

I worked as a diatary aide in a nursing home, and even my short time there, i witnessed...

1. I heard about an altheimers patient getting over a fence on at least 3 occasions and found wandering off the grounds hours later.

2. nurses aides "forgot" a patient, several times after lunch, and she was sleeping at the table where they left her.

3. A sweet old GENTLEMAN in a wheelchair, had to admit very embarrassed, that he'd wet himself. There was no one else around for him to tell. So I a kitchen worker, wheeled him back to his ward, and tried to tell a nurse aid the problem discretely. The aids were running around pell mell, and said, we're busy, we'll get to him when we can". So I had to leave this probable VETERAN there, with a hopeless look. Would you want this to happen to you, or yours?

4. only lady, whom apparently couldn't chew, needed her meals pureed. She had the SAME meal, the same day of the week, week after week, the whole time I was there, watered down plain "mashed" potatoes, meatloaf with gravy, and peas, all pureed to be drinkable.

Well one day I decided to put a bit of gravy in those watered down potatoes, (over stepping my bounds?) well there was gravy on the meatloaf, so I just took a spoonful she would have gotten with that, and put it in with the potatoes instead of the meatloaf, which also had some. Anyway, this surprise, must have made her happy because a RELATIVE of hers came and personally thanked me.

5. I saw a "victorian" lady w

5:15PM PST on Jan 29, 2014

Thank you for sharing this post

12:35PM PST on Jan 29, 2014

The lucky ones will die before having to enter nursing care facilities and/or engage less than caring at-home assistance ... the rest will become just medical waste or room and bed numbers. Overall, humankind, in my opinion, is at an all-time low.

Societies used to cherish the olders of the family and hold them in high esteem (maybe that's part of the problem, no "family" just a me-first generation). Can't wait until they peak and start on their own road to experience the limits of aging. Only then will the problems involved hit home ... and well deserved. Too bad so sad.

If you know of someone presently in such a situation, a humane act of kindness such as an occasional phone call or visit can make a huge difference to a confined or forgotten person ... maybe think about it?



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