CLOSING THE DOOR ON HOME CARE
Ervin, Mike
Closing the Door on Home Care BY MIKE ERVIN Last winter, Constance Barna of Syracuse, New York, received a letter that knocked the spirit right out of her. Barna is in a wheelchair because of a...
...That sparked a massive rowdy protest, the likes of which, one Chicago commentator noted, had not been seen in town since the 1968 Democratic convention...
...That's about three hours a day...
...Pataki figured he could reduce hours by having workers no longer do things like cooking and errand-running...
...Illinois's Edgar signed on, too...
...They took tfai from the hours they cut from recipients They called them 'efficiencies.'" Simmons says these efficiencies were the key to the company's claim that it could provide cis at a lesser cost...
...During the two and a half years National Home Care had the contract, Simmons estimates, she went through about twenty providers...
...The letter said that because of Governor George Pataki's plan to cut $1.2 billion from the state Medicaid budget, her hours of in-home aid would be cut so drastically that One case involved a woman whose food was so poorly kept and prepared she got food poisoning...
...It also said county officials were not informing recipients of their rights and that National Health Care was cutting corners on service delivery, "on the assumption that a family member or friend will meet the service needs without compensation...
...When the experiment came down, she was forced to dismiss the only provider she'd employed for years...
...In the end they defeated the cuts in home assistance...
...One plaintiff was a newly disabled woman who was ready to resume life after months in a rehab hospital...
...Barna is in a wheelchair because of a progressive neuromuscular disorder...
...Local disability activists, responding to Pataki's assault, had organized a public forum for later that day...
...There is a mountain of evidence that home assistance costs less that half what nursing-home incarceration costs...
...This new assertion of states' rights is as bankrupt as it was when it was the battle cry of the Jim Crow racists...
...We are fully prepared to provide health care for our most vulnerable populations, without prescriptions and mandates...
...But the kind of flexibility they seek is the freedom to dump those people with disabilities who need the most support at the mercy of expensive institutions and outrageously neglectful managed-care programs...
...The worst lie of all is that it's being done in the name of fiscal sanity...
...A judge ruled that since Medicaid is an entitlement, Edgar had no right to create a waiting list...
...But maybe his plan will blow up in his face," Shoultz says...
...They claim to be frustrated humanitarians who would like to bring on the good life for people like Constance Barna, if the mean old feds would only allow them the creativity to do so...
...Recipients must be very low-income or on welfare, which adds an insurmountable work disincentive...
...As Barna's friend and fellow disability activist...
...The experiment was finally ended last July...
...A lawsuit was filed...
...month to 100...
...Barna was receiving more than 100 hours in a week...
...But the timing of the letter was in one way fortunate...
...The room was packed to standing room only...
...Word is that President Clinton is insisting on retaining a disability entitlement while the Newtonians are adamant in their opposition...
...JB Says James Simmons of Tulare/KM Legal Services in Visalia, "I would hawE agree with that assessment...
...Bonnie Shoultz...
...And his Medicaid proposal still makes cuts that would probably be a considerable point of contention had the draconian Republican plan not made them look so relatively humane...
...It means they don't have to go through an intermediary agency, and gives them control over whom they hire and how things are done for them...
...The government obtained the necessary federal Medicaid waivers and turned all recipients over to a single vendor, National Home Care Assistance of Chicago...
...When people end up institutionalized as a result of "flexibility," no one will benefit...
...The counties would have complete authority over the amount of service they provide, and whom to serve...
...Currently, the federal government mandates that states provide certain minimum services for people on Medicaid...
...That entitlement is the subject of hot debate in Washington...
...The idea was for legislators and the press to hear in undeniable human terms the consequences of Pataki's plans...
...Last October, when members of the Senate Finance Committee, including some Republicans, attempted to restore a semblance of the disability entitlement to Medigrant, twenty-six Republican governors sent a protest letter to Senate Majority Leader Bob Dole...
...We are pleased with the flexibility provisions incorporated in the House measure...
...In order for Pataki to give counties carte blanche to abandon anyone who is too much trouble, the federal government would have to abolish the Medicaid entitlement...
...But the discharge planners told her about all they could do for her was help her find a nursing home since home assistance was now frozen...
...Flexibility" seems to be the euphemism of choice among the governors who salivate over block grants...
...read the letter, there was total silence...
...The letter was from an agency that employed her in-home assistants...
...And, of course, California's Wilson signed on to the letter, too...
...Workers are paid minimum wage...
...There is a mountain of evidence that home assistance costs less than half what nursing-home incarceration costs...
...Pataki's plan was to limit the hours of home care anyone could receive in a Mike Ervin is a freelance writer and disability-rights activist in Chicago, who writes frequently for The Progressive...
...Gubernatorial block-grant freaks like Pataki, Wisconsin's Tommy Thompson, Michigan's John Engler, California's Pete Wilson, and Illinois's Jim Edgar have been applying pressure from below...
...The governors warned that they would not "sit idly by" amid attempts to saddle them with "onerous" individual entitlements...
...But the capitation program, launched in November 1992, took that away from the 4,000 recipients of Tulare County...
...That brings us to the story of his state's infamously bone-headed experiment, the Managed Care/Capitation Demonstration Project...
...Activists held demonstrations and lobbied legislators statewide...
...I suppose the $60 billion nursing-home empire and the managed-care suits will make out quite nicely.S...
...It said the county was failing to protect residents and "creating potentially unsafe conditions...
...In 1992, he tried to limit the number of people who could be served by home assistance...
...But Wisconsin's Governor Thompson was, and just last year he tried to eliminate entirely his state's home-assistance program...
...She has little mobility or speech capability...
...Soffie said they had gone for days without any workers showing up...
...But recipients were often left hanging One case he particularly remembers was that of a woman whose food was so poorly kept and prepared she got food poisoning...
...we can only encourage you to make provisions" to go into a nursing home "as soon as possible...
...But one good thing about the California system is that recipients are allowed to hire anyone they want to provide their assistance...
...If it meant those dumped would be sentenced to a nursing home, too damn bad...
...In fact, just four months into the contract, someone from within the state agency charged with assessing the program leaked a summary of the preliminary assessment to Legal Services...
...Blane Beckwith calls the subsequent experimttt "a total, miserable failure...
...Mark and Blane Beckwith, two brothers from Berkeley who use motorized wheelchairs, say this provision is vitally important to them...
...The buzz in disability-activist circles is that the Medicaid entitlement is one of the sticking points holding up a budget agreement...
...BaseJK government data, Simmons estimates, ¦ company profited $4 million annually frX the monopoly contract...
...But now, Shoultz says, Pataki's current budget proposal calls for Medicaid funds that support home assistance to be block-granted to the counties...
...Big protests broke out and eventually Thompson had to settle for the kind of cap on hours Pataki coveted...
...No wonder Edgar finds the disability entitlement "onerous...
...The "Medigrant" proposal that passed the House removes all requirements, and gives Medicaid money to states in the form of block grants...
...Even worse, Shoultz says, Pataki throws in a powerful incentive for them to cut people like Barna loose by allowing them to keep whatever money remains at the end of the fiscal year and spend it on other things...
...Still, hundreds of Wisconsinites are facing the prospect of being dumped (see Page 20...
...When Legal Aid put a notice in the [taper seeking people who had complaJM about the program, they got about fjo dozen calls a week, Simmons says...
...Well, almost no one...
...State Medicaid funds would only pay for them to perform dressing, bathing, and other basic hygienic tasks...
...But Clinton has said he agrees with the concept of block grants...
...Pataki, oddly enough, was not among the letter's signatories...
...California's home-assistance program leaves a lot to be desired...
Vol. 60 • March 1996 • No. 3
