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Stuff to know about . . . The history of the "nursing-home bias" Why don't states let people get assistance in their homes, rather than putting them in nursing homes and other institutions? In the past, disability was regarded as a medical condition that prevented people from participating in most activities of daily life. Many people with disabilities were segregated and isolated from society, housed in large institutions without consideration of appropriate, less restrictive, alternatives. In 1965, Medicare and Medicaid legislation was passed that provided strong financial incentives to provide long term care in nursing homes. Medicare and Medicaid legislation came to guarantee public payment for institutional services. Nursing home care in the United States is an entitlement -- any person who is eligible for nursing home services cannot be denied that service if there is a nursing home bed available. But personal assistance services delivered in the community does not have such entitlement status. There is still a strong institutional bias in federal and state policies which provide funding for long-term services. From Consumer Choice and Control: Personal Attendant Services and Supports in America: Report of the National Blue Ribbon Panel on Personal Assistance Services, August, 1999   The money involved "Medicaid, a joint federal/state health financing program for low-income Americans who are aged, blind, or disabled, is the principal source of public funding for long-term care, with 1998 expenditures of $59.1 billion. In 1996, Medicaid accounted for 38 percent of total long-term care spending," says the General Accounting Office. Between 1987 and 1998, community-based long-term care expenditures increased from 10 percent to 25 percent of Medicaid long-term care spending. The fastest growing expenditures are for Medicaid home- and community-based services (HCBS) waivers, which grew at an average annual rate of 31 percent between 1987 and 1998 -- three times as much as the personal care services (PCS) optional benefit. From Adults with Severe Disabilities: Federal and State Approaches for Personal Care and other Services,published May, 1999 (GAO-HEHS 99-101). Download from http://www.gao.gov/ Spending for long-term services for "the elderly" totalled almost $91 billion in 1995, the most recent year for which expenditures from all sources were available, says the General Accounting Office. Almost 40 percent of these dollars were paid for by "the elderly and their families" and almost 60 percent by Medicaid and Medicare, but "these amounts, however, do not include many hidden costs of long-term care, since an estimated two-thirds of the disabled elderly living in the community rely exclusively on their families and other unpaid sources for their care." From Long Term Care: Baby Boom Generation Presents Financing Challenges, published March, 1998 (T-HEHS-98-107). Download from http://www.gao.gov/) The financial eligibility criteria for receiving personal care services in the community should not be more stringent than the financial eligibility criteria for institutional placement, says The National Blue Ribbon Panel on Personal Assistance Services. Medicaid and SSI asset and income limits for persons receiving long-term services in the community should be changed to allow individuals the greatest opportunity to remain in the community and not be forced into an institution. For example, recipients of home- and community-based services could be allowed to retain the equivalent of 6 to 12 months of expenses, and the maximum income requirements for qualified disabled working individuals could be relaxed. This must apply equally to all persons who meet institutional criteria, regardless of the program type (e.g., Personal Care Option, home- and community-based waiver services, etc.). From Consumer Choice and Control: Personal Attendant Services and Supports in America: Report of the National Blue Ribbon Panel on Personal Assistance Services, August, 1999     Freedom Clearinghouse is a project of Free Hand Press, publisher of Mouth magazine. Website developed by Cliffwood Organic Works. Website hosted by DIMENET. | E-mail | Home |