Site icon Beth Macy

Reform on the backs of the elderly

Cheryl Jones prepares Margaret Bass ("Mother Bass") for breakfast. Photo by Josh Meltzer

A home-care aide I know once scrubbed an elderly client’s toilet with balls of used tinfoil and denture tablets — because the old woman was too poor to afford cleaning supplies and too feeble to do the cleaning herself.

Many aides do less rigorous, but no less important, activities. They cook meals, check blood sugars and bathe people who can no longer bathe themselves. What they do — some for just a few hours a day — makes the absolute difference between a person staying home and a person going into that most-feared institution: the American nursing home.

Which isn’t just sad, it’s expensive. At an annual cost of $77,000 per person, prolonged nursing home stays force most middle-class elderly end up on Medicaid — just like two-thirds of all nursing home residents in America.

Among the many cuts to the state’s MassHealth program proposed recently by Gov. Deval Patrick, the most myopic is the one that calls for the administration to stop paying for personal-care or home-care attendants who serve patients fewer than 15 hours a week.

Sounds reasonable, at first glance, to remove the benefit from the least needy of the recipients. But anyone who has spent time in the company of a home-care aide will attest that those few hours a day are absolutely critical to the client who needs an insulin shot or her therapeutic socks changed or his invoices sorted so the light bill gets paid.

In fact, researchers working at Boston’s Hebrew Rehabilitation Center for Aged found that when screening to see who was at the greatest risk of institutional placement, seniors who could no longer take out their own trash ranked near the very top.

“Taking out the trash is a relatively time-limited task,” said Elise Bolda, health policy professor at the University of Southern Maine. “And yet without it you really can’t continue living in your own home.”

Paying a home-care agency $19 an hour for part-time chores and companion care seems like a steal compared to the $219 per day it costs to fund a semi-private room in a nursing home.

Medicare-funded home health programs have also come under attack in Congress, with reform proposals calling for millions of dollars in cuts that seem at odds with the Obama administration’s stated cost-savings goals of reducing hospital re-admissions.

Sure, it’ll cost four times as much to put aunt Agnes in a nursing home, the logic goes, but if that money is coming out of a different taxpayer pot, we still get to claim the home-care savings, right?

Right now 76 million American baby boomers are slouching toward retirement, a demographic shift that’s unprecedented in the history of the world. When Medicaid and Medicare were designed in the mid-‘60s, family members lived closer to each other, not as many women worked and people with chronic illnesses didn’t live as long as they do today.

Forty-five years later, we’re left with a confusing array of home-care offerings with different payment requirements, eligibility criteria and reimbursement systems, not to mention coverage limitations that make for huge gaps in services.

I know a 60-year-old woman, an executive secretary for a hospital president, who was too young to retire, and yet she couldn’t afford to pay a home-care aide to watch after her 69-year-old demented husband while she worked.

Veterans Affairs benefits paid most of his adult-day care bill for several months, but when his dementia worsened and he could no longer stay at the center, a social worker told her there was nothing else the VA could do to help her keep her husband at home. “We’re sorry, there’s no program for that.”

Who’s going to take care of us baby boomers when we’re old and frail? Who’s going to help us take care of ourselves?

The politicians need to be asking these questions rather than masking them with disingenuous talk of cost-savings and so-called reform.

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