Wiping somebody's butt is not a "medical procedure."
Nearly all attendant services can be performed by any trusted person.
Over-medicalizing long-term care is costly to taxpayers (see below).
Further, it requires that people who need assistance, whether they're
young or old, be labeled as sick. We are not, for the most part, sick.
We get by just fine out here in the real world with a little help.
Birth of a great American cash cow
Forty years ago, the nursing home industry barely existed. A relative
few church and county "homes for the aged" provided shelter and minimal
care for people who needed some assistance in order to survive but
had no money to hire it or families to provide it. Mothers, sisters,
aunts and grandmothers did the majority of America's caregiving.
Then, in 1965, came the birth of the "care industry." Congress passed
amendments to the Social Security Act which created Title XIX, the
federal legislation authorizing Medicare and Medicaid. Medicaid, which
now funds nearly two-thirds of America's nursing home beds, was originally
designed to help older, impoverished Americans pay for prescription
drugs (sound familiar?) and nursing care.No one at the time thought
that the nursing care part would be popular.
Today the nursing home industry is a growth industry. And its bills
are eating state budgets alive.
Medicaid is a joint federal-state program. Under Medicaid policy
which was devised in 1965 and is still in effect, all states must
offer institutional long-term care. Home- and community-based services
are optional. Moreover, the amount which Medicaid may spend on
home-and community-based services - the kind most folks need - are
optional. States do not have to offer them.
When states do offer such services, they often fence them in with
wild and crazy eligibility requirements like, "must be between the
ages of 22 and 51, require services which cost no more than 85 percent
of nursing home costs, and have been a participant in a state vocational
rehabilitation program between the years 1975 and 1990." Yikes!
Moreover, the amount which Medicaid may spend on attendant services
is capped. No such cap exists for institutional living arrangments.
That's what's called "institutional bias."
"I don't want to be a burden."
None of us wants to return to the days when mothers did all the
caregiving. None of us want to live, or have family members live,
in institutions. People who make a living off knowing what's best
for others, allied with people who profit from the current incarceration
method of "care," have designed a system about us, without us.
People like me who have survived that system abhor it and work to
change it. Today, thanks to the Supreme Court's ruling in Olmstead
v. L.C. and E.W., we have the law on our side. Giving people what
they want rather than what professionals perceive to be their "need"
is both less expensive and more satisfying to all concerned, including
the taxpayer. Unlike institutions, home- and community-based services
can be flexible, individualized, and built on the human scale.
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publisher of Mouth
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