My home state of Massachusetts, like most of the country, is eliminating or limiting the availability of services like eye care, dental care, prosthesis, and wheelchair repair to Medicaid recipients. They've also reduced the amount of money you can earn and still be eligible for MassHealth (Massachusetts State Medicaid). However, the really sad part is that the State thinks its saving money by doing these things. It's not. Not being able to see, get around, or chew without pain makes it harder, not easier, to get a job and get off assistance; not to mention the fact that most disabled people and poor people have quit the part-time jobs they were holding for fear of losing life saving benefits like personal care assistance and prescription drug coverage which means the state must give them money for survival needs like food and rent, instead of just health coverage.
I think it is ironic that while Massachusetts is busy cutting necessary services to disabled people and low income throughout the State, the one thing they are not doing is trying to transition as many people as possible into community care as quickly as possible. As I mentioned in previous columns, this would save the State thousands of dollars per person, per year. I get 15 hours of care a day and my personal care assistants (PCAs) get $10.60 an hour. My yearly bill is less than 67% of the $87,500 I would cost the State if I lived in a nursing home, where I couldn't go to grad school, volunteer, work, set my own hours, or have any freedom at all. Even if someone needed round the clock care (which most people don't) you could pay his/her personal assistant $10.01 per hour and still save over $12 per year over the cost of keeping them in a nursing home in my state.
As much as my state's bean counters need a math lesson, I know that Massachusetts is no different than most of the country. According to the first quarter report from the Centers for Medicare and Medicaid Services (CMS), nearly 1.4 million people across the nation, including 43,159 in my own state want to transition from nursing homes to community based services, even given the often abysmal state of such services currently. That's over 20% of the total nursing home population! However, nursing home services are an entitlement under Medicare and Medicaid, while community based assistance is optional; yet according to same report every state has empty nursing home beds, while there are often multiple year waiting lists for community services.
According to the 2004 MetLife Market Survey of Nursing Home and Home Care Costs, the average cost of living in an American nursing home for one year is $70,080. Now let's assume that, like me, one community based personal assistance services user requires 15 of care a day (more than most people do) and also pays his or her assistants $10.60 an hour (more than $1.50 over the living wage amount for full time work by national standards and much more than most PCAs in America get). That consumer would save his or her state over $12,000 per year! If just half of the 1.4 million nursing home residents who want to live in the community needed the same amount of support (bear in mind, most people need less), with the same PCA pay rate as our hypothetical consumer the nation would save 9 billion dollars a year! That money could be used to stave off the 8.5 billion dollars in Federal Medicaid cuts purposed by President Bush in their entirety, provide a million $900 Section 8 vouchers to low income housing seekers, or revive and improve our flailing mass transit system- a life line for most disabled, low income, and non-car owning Americans as well as our planet's health. Perhaps most practically, the extra funds could be used to support those few consumers whose community based care will cost more than keeping them in a nursing home, raising the national PCA wage to the living wage standard, and providing assistants with an adequate healthcare plan. However the money is spent, it will be put to far better use than the imprisonment of 1.4 million Americans who deserve to be part of their local communities.
As disability rights advocates, we must demand a redirection of nation's long-term care dollars. We must support bills such as the Medicaid Community Attendant Services and Supports Act (MiCASSA), House bill 910 and Senate bill 410 (which mandates that community based services be provided from birth to death, as long as the services are medically necessary and the service recipients are Medicaid eligible, as well as having a buy in option for higher income people) and Money Follows the Person, Senate Bill 528, which allows people who have resided in a nursing home for at least six months that use the money that is being spent on them in the institution to pay for their community based assistance services. We must arm ourselves with information, such as that contained in the latest CMS report, and be prepared to defend the pro-community position against the defenders of the institutional placement bias. Most importantly, we must educate our family, friends, and neighbors about the injustices of our long-term care system. We fail to do so at our peril.
Editor's Note: Reach Out would
like to thank Ms. Martina Robinson for this very exciting, informative
and thought provoking article. To learn more about Martina you can visit
her website at: http://webpages.charter.net/martina_robinson
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