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Cuts 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.

Date: 2010-07-22 08:15 am (UTC)
mc776: The blocky spiral motif based on the golden ratio that I use for various ID icons, ending with a red centre. (Default)
From: [personal profile] mc776
My experience tells me that the ones most likely to embrace the more callous forms of social darwinism tend to be the ones with the least societally useful employment.

Also I want to have Article I section 8 person's manbabies.

Date: 2010-07-22 03:54 am (UTC)
From: [identity profile] ksol1460.livejournal.com
Wait just a God damned minute. Who's going to teach the kids "engineering, math, english, other languages, science" if you kill all the old people?

I couldn't even finish reading. Disrespect for old people makes my head explode.

Date: 2010-07-22 05:23 am (UTC)
From: [identity profile] leora.livejournal.com
Also, just to be clear about what we're talking about these people living on, when they say she gets $803 per month, I'm guessing that is the listed amount social security says she gets. Her medicare payment comes out of that and will be about $50 to $60 per month. So, her actual to live on income will be about $750. Given her monthly number looks pretty much the same as mine. When she mentioned no cost of living increase, that was likely referring to the fact that every year social security adjusts for cost of living. Most years this seems to mean the payment goes up by about $20 or so. But from 2009 to 2010 it was deemed that the cost of living had not increased, so the payments did not either. So, you have to hope none of your bills went up. Any increases in expenses will hit hard.

Now, she won't have to pay for medical care assuming she is also on medicaid, because as long as she has no possessions of value, medicaid will pay for everything after your income is dropped down to $800 per month (any money you have more than that must go to medical bills before they'll pay a dime for that month), but she's poor enough that her doctor's visits are free. However, since she can stand and walk a little, it'll be hard for her to qualify for a wheelchair or most other disability aids. And any expenses or aids needed in order to go to a doctor's appointment or to a grocery store or any other errand is not covered, because medicare explicitly states that they cover your mobility needs within your own home to do basic tasks like going to the bathroom, but the ability to travel to see a doctor or buy groceries is not a guaranteed right. So, she's paying for whatever it takes to do that however she can do that. How well you can do that on $750 per month for all of your expenses depends a bit on where you live. But she really can't afford to spend too much on cabs or people running errands for her.

It really bothers me the way they often take cuts that make people more dependent, which are both not cost effective in the long run and also outright hurt quality of life. Often just a bit more assistance is better all around, as this article says.

Which all just says that the system is deeply flawed, but I can't fix it either. :/

Date: 2010-07-22 01:23 pm (UTC)
From: [identity profile] marveen.livejournal.com
as long as she has no possessions of value

And you haven't even touched on how cruel that part is.

Anyone who was responsible in their youth and middle years, saved their money and paid their bills, and HAS a car, a house, etc., will have them taken away as part of the devil's bargain the State makes for helping with medical bills.

Date: 2010-07-22 07:20 pm (UTC)
From: [identity profile] leora.livejournal.com
Well, yes. That's why my brother opts to only spend $10,000 a month on medical bills rather than twice that, because he can't afford that and to get the state to cover it would require giving up his house.

I got ill when I was young and poor, so I had nothing to lose. So, I didn't learn the specifics of which things they let you keep and which they do not.

Date: 2010-07-23 09:10 am (UTC)
From: [identity profile] elenbarathi.livejournal.com
The government of this country is not here for the people, and the reason is because We the People can't be arsed to take a hand in it.

What can we do? Three things - the same three things we've been able to do right along:

1. Vote.
2. Write.
3. Spend.

#1 sounds easy, and so it is, but it requires that We the People expend the time and effort to learn about the candidates and issues we're voting on - not just on the national level once every four years, but for everything from our local City Councils on up. If all the candidates suck, then find someone who doesn't, and get out and campaign for him or her.

#2 is easy too, and people who crank out multiple paragraphs every day on their blogs could certainly find the time to write a brief e-mail or postcard to an elected official, a corporate CEO, or the editor of a publication about whatever issue seems most pressing that day. Passing news-of-issues around on the 'Net is helpful and useful only if the receivers of the news do something about it besides just passing it on.

#3 is probably the most difficult, because it involves a lot of not spending, and people in this country aren't so good at that. But "voting with the purse", not buying from companies whose policies you oppose, is one of the most effective methods of creating change.

As far as the thing with the elderly goes, I can't feel too sorry for a generation that has consistently voted in favor of military spending and against social services for the past fifty years. "People mostly get the kind of government they deserve" - many of your readers are probably too young to recall the Reagan Administration, but a lot of the folks who are crying now were all in favor of chopping everybody else's care 30 years ago. They've also been cheering on this useless, evil, hideously-expensive war in the Mideast since the beginning, and now they wonder why they're not being 'taken care of' by a government up to its ears in debt?

Clue Trout Time: the government as it currently stands belongs to those who have been arsed to take a hand in it while the citizens have been off playing World of Warcraft or whatever: namely, the rich and powerful, who've made themselves rich and powerful by so doing. They're not going to give up any part of their wealth or power unless they're forced; certainly not to make life easier for The Poor.

The so-called Health System, and the Insurance System that goes with it, is intolerable, and if every person who finds it so was to start e-mailing their Congress-critters about it on a weekly basis, we'd see some change pretty quick. Meanwhile: that's right: if one gets sick or injured, and/or lives to be old, one can expect no help from the State. One might be able to wangle some, especially if one is good at wangling (or can hire someone who is) but one also may incur a crippling debt only to get 'care' that doesn't care and 'help' that does more harm than good.

Everyone knows they 'should' be taking better care of their bodies - 'should' be eating healthier food, taking vitamins, exercising, taking care of their teeth, getting free of their unhealthy habits, driving more mindfully - and many make brief, sporadic attempts at doing it, but then lapse back into their old ways. Well? Our society 'should' take care of its most vulnerable members and it makes sporadic attempts to do so - mostly when enough people get angry enough to insist on it - but then it lapses back into its old ways.

People get well when they stop 'shoulding' and actually do. The same with societies. When We the People stop griping about how it 'should' change, and instead do the things that will change it, we will get the government we want.

I'm totally in favor of getting rid of all the 'useless eaters'. In fact, if I ever become a vampire, I plan to spend my winters in Washington D.C. and take a hand (or, rather, fang) in reducing their numbers myself. (Summers, I'll come home to the Olympic Peninsula and sparkle.)



Date: 2010-07-23 09:50 am (UTC)
From: [identity profile] elenbarathi.livejournal.com
I say put a Senior Center in every Middle School; require all students to work in it one day a week for one quarter of 7th grade Health, but also use it as a tutoring pool where feasible. There's no reason 12-year-olds can't prepare and serve meals, clean up, wheel folk in chairs around, play cards and converse - of course there'd have to be an adult aide to help in the bathrooms or with any medical-type procedures, but most of taking care of old people is pretty simple. And a lot of young people could seriously benefit from finding a surrogate grandparent to talk with.

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