Long article
Jul. 20th, 2010 09:11 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
conulyCuts in Home Care Put Elderly and Disabled at Risk
Cuts in Home Care Put Elderly and Disabled at Risk
By JOHN LELAND
HILLSBORO, Ore. — As states face severe budget shortfalls, many have cut home-care services for the elderly or the disabled, programs that have been shown to save states money in the long run because they keep people out of nursing homes.
Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.
For Afton England, who lives in a trailer home here, the news came in a letter last week: Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents, including her. Ms. England, 65, has diabetes, spinal stenosis, degenerative disc disease, arthritis and other health problems that prevent her from walking or standing for more than a few minutes at a time.
Through a state program, she has received 45 hours of assistance a month to help her bathe, prepare meals, clean her house and shop. The program had helped make Oregon a model for helping older and disabled people remain in their homes.
But state legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.
“They yanked the rug out from underneath us,” said Ms. England, who lives on $802 a month from Social Security. “I’m scared. I’m petrified. I can’t function on my own. I took care of my husband for eight years. Already I’ve given up many of my freedoms. Now they’ve taken our dignity. I’d like them to try living in my body for a week.”
Her case manager, Brandi Lemke, shook her head. “This is not saving any money,” she said.
Ms. Lemke said she feared that Ms. England would “end up in the hospital because of the diabetes” and be in assisted living by the end of the year. “If she takes a fall,” Ms. Lemke said, “she may require more than assisted living can handle.”
Nursing homes here cost the state an average of $5,900 a month; home and community-based services cost $1,500 a month.
Other states have made similar cuts:
¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.
¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.
¶Arizona sliced independent living supports and respite programs for family caregivers.
¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.
In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.
“I’m not getting a cost-of-living adjustment, and now I’m not getting food,” said Joyce Plennert, 83, who is on a waiting list for Meals on Wheels in Palatine, Ill. “Now I’m worried my home services will be cut. Without that, I’d be in a nursing home, if I could find one with room.”
Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.
In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents. The Legislature rejected these cuts but has not yet produced an alternative budget. The state already cut Alzheimer’s day care centers and assistance for caregivers.
Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.
“The situation is grim, and it’s safe to say that present trends are expected to continue,” said JoAnn Lamphere, the director of state government relations for health and long-term care for AARP. “Nearly every state has proposed cuts of some sort to Medicaid. Some might seem small, but it’s death by a thousand slashes.”
The cuts in Oregon have been particularly painful to people who work with the elderly, because for more than three decades the state has been a leader in rebalancing long-term care away from nursing facilities and toward the home. The cuts here indicate how fragile these services can be against states’ needs to reduce spending.
“I’m seeing in a matter of months 30 years of work go down the drain,” said Donald Bruland, the director of senior and disability services for the Rogue Valley Council of Governments.
The state spends more than half its Medicaid long-term-care dollars on home care and has a separate $13 million program for people who do not qualify for Medicaid; on average, states spend just 25 percent of their long-term-care budgets on home and community-based care.
Bruce Goldberg, director of the Oregon Department of Human Services, said the agency did not have an estimate for how many of the people losing home care would end up in assisted-living facilities or in nursing homes — or, if they did, how the state would pay for them.
“We’re in new territory,” Dr. Goldberg said. “Long-term care is a cobbled-together system with many holes, and they just got deeper.”
Last week, the Oregon legislature’s emergency board scheduled a session for Thursday to reconsider some of the cuts.
In Portland, Ken Poe, 66, requires assistance because of polio, which he got when he was 9. He has little muscle strength and requires oxygen constantly. The state provides 20 hours of care a month in his home.
Mr. Poe, a former pilot and flight instructor, lives as independently as he can, he said — he still drives, though he needs help getting to and from his car — but said he could not afford to pay his aides on the $1,300 a month he gets from Social Security. He often borrows money from a home credit line at the end of the month. Because of severe osteoporosis, he worries about falling in the shower without an aide.
“There are times when I’m struggling to get to the kitchen when I wonder how much longer I can do this,” he said. “But this is my comfort zone. It may look like a mess” — he gestured to cardboard boxes filling the living room — “but the boxes are my system for getting around. Moving to an assisted-living facility would bring on a depression.”
For states, having to cut the Medicaid programs is a double loss, because they come with matching dollars from the federal government. This creates state jobs and much-needed revenue.
Without these, said James A. Davis, a gerontologist at Marylhurst University and executive director of United Seniors of Oregon, “it really is a death spiral.”
“So often the programs to go are the early interventions that save money and keep people healthy,” Professor Davis said. “That comes back to bite you.”
And... the comments!
Not all of them, just some of the choice ones.
This on the heels of news that we've spent $1 trillion on the "war on terror." Boy, has this nation got its priorities backward.
Indeed.
a society that cannot care for it's old and infirmed is one that is spending its resources unwisely and lacking in humanity
This too.
We have to stop pouring money down this sinkhole.
Instead of spending on seniors, we should be spending on the next generation's labor force. Education for kids. Our current kids can barely multiply. They can barely add. They can barely read.
And we're pandering to the interests of seniors?
Enough.
Seniors don't produce or add to our economy. They should not be lavished with tax money. They should be the responsibility of their families. Or they should just live off what they saved.
Our economy is going to suffer if we spend on old people instead of making investments for the future. Our kids need to learn engineering, math, english, other languages, science.
Our seniors need to step back and respect that.
Outraged in Oakland doesn't plan to get old, apparently. I guess he's thinking that when he gets hit by a car, he'll be considerate enough to up and die.
I'll keep this simple - Any country, any society which forces it's most vulnerable citizens to bear the brunt of budget cuts while it has a thirty year history of cutting the tax rates of its most well off citizens is a deeply sick society. If you are wife beater, child abuser, alcoholic, etc, you look yourself in the mirror and say "What's wrong with me. How can I change?"
America with it's boated defense spending, 16% of its kids in poverty and expendable elderly should do the same.
Fundamentally, psychologically, down deep in our soul, we are sick.
(Okay, I don't have the energy to fight EVERY comment I quote!)
"I'd like them to try living in my body for a week." Agreed, I certainly wouldn't want to do that. And why should she continue to want that? And why should taxpayers be forced to help her continue to do that? When quality of life disappears, life itself should disappear. Only then is dignity maintained.
When M.E gets old, or is disabled, when it is HER mother or HER kid who needs the help, that when I want somebody to show up at her door and wave this comment in her face. See what she says THEN.
Home care programs never did take the place of family caregiving, even in flusher financial times. We almost got to the point where it was recognized that assisting family caregivers, if in place, helped kept the elderly and disabled out of facilities.
They didn't? Gosh, I thought these programs kept folks in with suede toilet paper, but now you're saying their families still had to hang around?
The elite 1% continues to make mega-gains while the poorest and neediest pay for budget cuts. Tax cuts for the wealthy and take away the crumbs from the poor. This is the American way.
Every day, you hear people say things like this, but... what are we going to DO about it? Short of violent action (which doesn't seem to always work well anyway, and which should really be a very very last resort), what's the plan here to FIX things?
Actually, "Rob" (post number 6), Article I, Section 8, known also as the "General Welfare Clause," specifically empowers the Congress to "lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common defense and general Welfare of the United States."
That can be interpreted in a variety of ways. I, for one, believe that in order to fight terrorism, the country needs to be healthy (and educated). Thus, keeping people as viable as they can be via taxpayers is providing for the "common defense."
I vote for politicians who interpret the Constitution in the same way, including those who advocate a public option for healthcare. Fittingly, my vote is in accordance with the Constitution, according to my interpretation of the Clause, to which I am as entitled as you are to yours.
Hope that helps.
(In reply to "But... caring for old folks isn't in the CONSTITUTION!")
When looking for cost savings, the first place to look should be the salaries and perks of our elected representatives. It seems to me that grandma needs her meds a lot more than a congressman needs office staff, or a driver, or any other perks.
Well, let's not talk crazytalk now.
I have a severe disability, and I use home assistance here in California. This help is what enables me to go to school -- I'm almost done with a BA, and it has been difficult at times, to say the least. If I lose this help, most likely I will either have to take just one class per semester or drop out altogether. Then my chances of gainful employment, and of paying taxes, will be gone.
How is this better, for anyone involved? I noticed that in the article nothing was mentioned about the "Why?" of what the gov'ts are doing. Just several people saying that these cuts don't make any sense, and that they will actually end up costing us more. I kept waiting for the part where the writer questions some type of state legislature to ask them "Why, then, are you doing this?", but it never came. I know the answer would probably be unsatisfying, but having the question not asked at all was even more unsatisfying.
Another sensible comment.
I'm going to say this again until I pass out from typing it: If we can afford to wage two wars of choice and spend over $20 billion a month doing so, if we can rebuild Iraq and Afghanistan and literally hand out money hand over fist, then we can certainly care for the most vulnerable of Americans. This is getting ridiculous. You should see how much money we spend on schools, roads and reconstruction in other countries. We literally hand out millions if necessary to fix a problem. America has a terrible, terrible deep-seated problem that everyone seems to ignore: we really don't care about each other, but we are far too willing to spend billions on wars.
Yes, that.
Contrary to tea time thinking, health care reform will alleviate health problems associated with aging because people will be able to access preventative care before they become Medicare eligible. In the meantime, we have an obligation to provide care for our sick and disabled. If it means more taxes, so be it. By the way, the Constitution not only omits a guarantee of health care; it also fails to guarantee tax breaks for home owners, the wealthy, and corporations.
And still more sense (I'm really avoiding the silliest comments.)
Yes, there are people who are disabled; and there will continue to be such people. Yet, how many would not be in the fix that they find themselves had they chosen another, healthier, life-style?
...
Not all who are disabled are the result of either poor diets or activity levels, but I would wager that a good many who do suffer are the victims of their own poor habits.
Screw you.
All the useless eaters must go.
I'm not sure if this guy is trying to invoke Godwin here, or if he's serious.
Cuts in Home Care Put Elderly and Disabled at Risk
By JOHN LELAND
HILLSBORO, Ore. — As states face severe budget shortfalls, many have cut home-care services for the elderly or the disabled, programs that have been shown to save states money in the long run because they keep people out of nursing homes.
Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.
For Afton England, who lives in a trailer home here, the news came in a letter last week: Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents, including her. Ms. England, 65, has diabetes, spinal stenosis, degenerative disc disease, arthritis and other health problems that prevent her from walking or standing for more than a few minutes at a time.
Through a state program, she has received 45 hours of assistance a month to help her bathe, prepare meals, clean her house and shop. The program had helped make Oregon a model for helping older and disabled people remain in their homes.
But state legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.
“They yanked the rug out from underneath us,” said Ms. England, who lives on $802 a month from Social Security. “I’m scared. I’m petrified. I can’t function on my own. I took care of my husband for eight years. Already I’ve given up many of my freedoms. Now they’ve taken our dignity. I’d like them to try living in my body for a week.”
Her case manager, Brandi Lemke, shook her head. “This is not saving any money,” she said.
Ms. Lemke said she feared that Ms. England would “end up in the hospital because of the diabetes” and be in assisted living by the end of the year. “If she takes a fall,” Ms. Lemke said, “she may require more than assisted living can handle.”
Nursing homes here cost the state an average of $5,900 a month; home and community-based services cost $1,500 a month.
Other states have made similar cuts:
¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.
¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.
¶Arizona sliced independent living supports and respite programs for family caregivers.
¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.
In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.
“I’m not getting a cost-of-living adjustment, and now I’m not getting food,” said Joyce Plennert, 83, who is on a waiting list for Meals on Wheels in Palatine, Ill. “Now I’m worried my home services will be cut. Without that, I’d be in a nursing home, if I could find one with room.”
Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.
In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents. The Legislature rejected these cuts but has not yet produced an alternative budget. The state already cut Alzheimer’s day care centers and assistance for caregivers.
Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.
“The situation is grim, and it’s safe to say that present trends are expected to continue,” said JoAnn Lamphere, the director of state government relations for health and long-term care for AARP. “Nearly every state has proposed cuts of some sort to Medicaid. Some might seem small, but it’s death by a thousand slashes.”
The cuts in Oregon have been particularly painful to people who work with the elderly, because for more than three decades the state has been a leader in rebalancing long-term care away from nursing facilities and toward the home. The cuts here indicate how fragile these services can be against states’ needs to reduce spending.
“I’m seeing in a matter of months 30 years of work go down the drain,” said Donald Bruland, the director of senior and disability services for the Rogue Valley Council of Governments.
The state spends more than half its Medicaid long-term-care dollars on home care and has a separate $13 million program for people who do not qualify for Medicaid; on average, states spend just 25 percent of their long-term-care budgets on home and community-based care.
Bruce Goldberg, director of the Oregon Department of Human Services, said the agency did not have an estimate for how many of the people losing home care would end up in assisted-living facilities or in nursing homes — or, if they did, how the state would pay for them.
“We’re in new territory,” Dr. Goldberg said. “Long-term care is a cobbled-together system with many holes, and they just got deeper.”
Last week, the Oregon legislature’s emergency board scheduled a session for Thursday to reconsider some of the cuts.
In Portland, Ken Poe, 66, requires assistance because of polio, which he got when he was 9. He has little muscle strength and requires oxygen constantly. The state provides 20 hours of care a month in his home.
Mr. Poe, a former pilot and flight instructor, lives as independently as he can, he said — he still drives, though he needs help getting to and from his car — but said he could not afford to pay his aides on the $1,300 a month he gets from Social Security. He often borrows money from a home credit line at the end of the month. Because of severe osteoporosis, he worries about falling in the shower without an aide.
“There are times when I’m struggling to get to the kitchen when I wonder how much longer I can do this,” he said. “But this is my comfort zone. It may look like a mess” — he gestured to cardboard boxes filling the living room — “but the boxes are my system for getting around. Moving to an assisted-living facility would bring on a depression.”
For states, having to cut the Medicaid programs is a double loss, because they come with matching dollars from the federal government. This creates state jobs and much-needed revenue.
Without these, said James A. Davis, a gerontologist at Marylhurst University and executive director of United Seniors of Oregon, “it really is a death spiral.”
“So often the programs to go are the early interventions that save money and keep people healthy,” Professor Davis said. “That comes back to bite you.”
And... the comments!
Not all of them, just some of the choice ones.
This on the heels of news that we've spent $1 trillion on the "war on terror." Boy, has this nation got its priorities backward.
Indeed.
a society that cannot care for it's old and infirmed is one that is spending its resources unwisely and lacking in humanity
This too.
We have to stop pouring money down this sinkhole.
Instead of spending on seniors, we should be spending on the next generation's labor force. Education for kids. Our current kids can barely multiply. They can barely add. They can barely read.
And we're pandering to the interests of seniors?
Enough.
Seniors don't produce or add to our economy. They should not be lavished with tax money. They should be the responsibility of their families. Or they should just live off what they saved.
Our economy is going to suffer if we spend on old people instead of making investments for the future. Our kids need to learn engineering, math, english, other languages, science.
Our seniors need to step back and respect that.
Outraged in Oakland doesn't plan to get old, apparently. I guess he's thinking that when he gets hit by a car, he'll be considerate enough to up and die.
I'll keep this simple - Any country, any society which forces it's most vulnerable citizens to bear the brunt of budget cuts while it has a thirty year history of cutting the tax rates of its most well off citizens is a deeply sick society. If you are wife beater, child abuser, alcoholic, etc, you look yourself in the mirror and say "What's wrong with me. How can I change?"
America with it's boated defense spending, 16% of its kids in poverty and expendable elderly should do the same.
Fundamentally, psychologically, down deep in our soul, we are sick.
(Okay, I don't have the energy to fight EVERY comment I quote!)
"I'd like them to try living in my body for a week." Agreed, I certainly wouldn't want to do that. And why should she continue to want that? And why should taxpayers be forced to help her continue to do that? When quality of life disappears, life itself should disappear. Only then is dignity maintained.
When M.E gets old, or is disabled, when it is HER mother or HER kid who needs the help, that when I want somebody to show up at her door and wave this comment in her face. See what she says THEN.
Home care programs never did take the place of family caregiving, even in flusher financial times. We almost got to the point where it was recognized that assisting family caregivers, if in place, helped kept the elderly and disabled out of facilities.
They didn't? Gosh, I thought these programs kept folks in with suede toilet paper, but now you're saying their families still had to hang around?
The elite 1% continues to make mega-gains while the poorest and neediest pay for budget cuts. Tax cuts for the wealthy and take away the crumbs from the poor. This is the American way.
Every day, you hear people say things like this, but... what are we going to DO about it? Short of violent action (which doesn't seem to always work well anyway, and which should really be a very very last resort), what's the plan here to FIX things?
Actually, "Rob" (post number 6), Article I, Section 8, known also as the "General Welfare Clause," specifically empowers the Congress to "lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common defense and general Welfare of the United States."
That can be interpreted in a variety of ways. I, for one, believe that in order to fight terrorism, the country needs to be healthy (and educated). Thus, keeping people as viable as they can be via taxpayers is providing for the "common defense."
I vote for politicians who interpret the Constitution in the same way, including those who advocate a public option for healthcare. Fittingly, my vote is in accordance with the Constitution, according to my interpretation of the Clause, to which I am as entitled as you are to yours.
Hope that helps.
(In reply to "But... caring for old folks isn't in the CONSTITUTION!")
When looking for cost savings, the first place to look should be the salaries and perks of our elected representatives. It seems to me that grandma needs her meds a lot more than a congressman needs office staff, or a driver, or any other perks.
Well, let's not talk crazytalk now.
I have a severe disability, and I use home assistance here in California. This help is what enables me to go to school -- I'm almost done with a BA, and it has been difficult at times, to say the least. If I lose this help, most likely I will either have to take just one class per semester or drop out altogether. Then my chances of gainful employment, and of paying taxes, will be gone.
How is this better, for anyone involved? I noticed that in the article nothing was mentioned about the "Why?" of what the gov'ts are doing. Just several people saying that these cuts don't make any sense, and that they will actually end up costing us more. I kept waiting for the part where the writer questions some type of state legislature to ask them "Why, then, are you doing this?", but it never came. I know the answer would probably be unsatisfying, but having the question not asked at all was even more unsatisfying.
Another sensible comment.
I'm going to say this again until I pass out from typing it: If we can afford to wage two wars of choice and spend over $20 billion a month doing so, if we can rebuild Iraq and Afghanistan and literally hand out money hand over fist, then we can certainly care for the most vulnerable of Americans. This is getting ridiculous. You should see how much money we spend on schools, roads and reconstruction in other countries. We literally hand out millions if necessary to fix a problem. America has a terrible, terrible deep-seated problem that everyone seems to ignore: we really don't care about each other, but we are far too willing to spend billions on wars.
Yes, that.
Contrary to tea time thinking, health care reform will alleviate health problems associated with aging because people will be able to access preventative care before they become Medicare eligible. In the meantime, we have an obligation to provide care for our sick and disabled. If it means more taxes, so be it. By the way, the Constitution not only omits a guarantee of health care; it also fails to guarantee tax breaks for home owners, the wealthy, and corporations.
And still more sense (I'm really avoiding the silliest comments.)
Yes, there are people who are disabled; and there will continue to be such people. Yet, how many would not be in the fix that they find themselves had they chosen another, healthier, life-style?
...
Not all who are disabled are the result of either poor diets or activity levels, but I would wager that a good many who do suffer are the victims of their own poor habits.
Screw you.
All the useless eaters must go.
I'm not sure if this guy is trying to invoke Godwin here, or if he's serious.
