Does Anyone Care?
Does Anyone Care? Since the 1971 White House Conference on Aging, legislators and medical experts have been discussing ways to reduce the demand for institutional care. The full range of...
...A wide range of medical support personnel can be brought to the home: physical, occupational, and speech therapists...
...So most activist groups now are fighting merely to hang on to what they already have...
...her mother went to a nursing home...
...The first is money...
...Until their minds are changed, legislators are unlikely to vote for increased services—especially with budget cutting now running rampant on Capitol Hill...
...So perhaps what Stanley Brody, a psychiatry and geriatrics professor at the Hospital of the University of Pennsylvania, says is true: "It's really a question of values...
...All of these services, intended for people who do not require much medical care, exist here and there around the country, financed by charitable organizations or by public funds...
...A year and a half after all this began...
...they exist, says Brahna Tra-ger, a nationally known health expert, "mainly on the two coasts and in heavily populated urban areas, with little or nothing elsewhere...
...We like to think that we're a caring society...
...The full range of possibilities is extensive...
...licensed practical nurses, who administer oxygen, give injections, change sterile dressings and catheters...
...Sylvia also has an extensive family of brothers, sisters, in-laws, nephews, and nieces, with a certain amount of independent financial means, who made themselves available to give periodic care and relief...
...I have many friends who want to keep their parents at home," Sylvia says, "but they just can't afford it...
...But really, we're not...
...Many people think more varied forms of care would eventually save money, but they have no definitive data on which to base their arguments...
...I have a neighbor, whom I will call Sylvia, who wanted her eighty-four-year-old mother to die at home...
...Because Sylvia has severe rheumatoid arthritis and can not go to work, she was available to care for her mother full-time, within the limits of her own disability...
...All of them work full-time or attend school, so the amount of relief they could provide, especially during the night, was limited...
...Home health, where it exists, provides a supplement to that unskilled care...
...But the geographic areas where the skilled professionals can be found are limited...
...Much home health is paid for by Medicare for short periods...
...But that's where we all jerk off...
...But after about two months, the nurse in charge of the case judged that Sylvia's mother had improved as much as'she was likely to...
...Medical day-care centers are another option...
...Eventually it was costing them more to keep their mother at home than it would have to put her in an institution as a private, paying patient...
...We should be able to do it just because it's more humane...
...Humanity: People tend not to talk about the second aspect much...
...they require someone around the clock, living with them, caring for them...
...She went to the hospital...
...It includes volunteers who prepare and deliver hot meals, homemakers who visit periodically to help with housework and shopping, and congregate housing, where residents live independently in apartment clusters so that meals, light housekeeping, and quick access to medical personnel can readily be provided...
...S.B...
...and home health aides who passively exercise limbs, turn patients in bed, get them out of bed, and bathe, dress, and feed them...
...So the services were withdrawn and a homemaker, who could not exercise limbs or get a patient out of bed, began to come to the house four hours a week...
...The issue of more government support for home health has two main aspects...
...Like other forms of alternative care, it is an effort to keep old people out of hospitals and nursing homes...
...As Sylvia's mother got worse and Sylvia herself grew more and more exhausted, the family members pooled their financial resources...
...Yet she and her family were getting the most and the best home health aid Medicare has to offer...
...Congress remains unconvinced that caring for the elderly out of institutions is less expensive than caring for them in institutions...
...All of it is directed toward the medical needs of the patient, none of it toward giving some respite or relief to a besieged family member providing the bulk of the daily care...
...They hired supplemental help: seven hours of respite three times a week at six dollars an hour...
...Sylvia had a heart attack...
...The situation deteriorated, and the family purchased more and more home health time...
...Home health is another kind of alternative care intended for those who need more extensive medical support...
...Generally, they provide six or seven hours of social activity in a group setting, as well as some limited medical supervision...
...Because even if you go into a home as a private patient, eventually you go on Medicaid...
...Our level of commitment to the quality of life...
...Home health recipients are too sick to live independently...
...Ordinarily, that someone would be a dedicated but unskilled family member...
...At first, Medicare provided a physical therapist two hours a week and a nurse's aide four hours a week, so Sylvia had someone to help her exercise her mother's paralyzed limbs and get her out of bed...
...The justification for this shouldn't be cost...
Vol. 45 • November 1981 • No. 11
