Obama Talks the Talk on Home Care, But…

There’s acute anger among the disabled community at a perceived lack of leadership on the Community Choice Act by the White House, particularly on whether increased investment in home care will be part of the overall health care reform legislation.  As blogged by Dora on the Autism page, the dominant feeling is betrayal.  Given Obama’s past full-throated support of the Community Choice Act as a Senator and his campaign promise to increase opportunities for home care, you’d think reforming the payment for long term care would be a must have, not something placed in the “wait and see” pile.

The sense of betrayal is both real and entirely understandable.  After all, Obama was different.  Hillary Clinton and John Edwards told stories about people who had been left exposed and left behind by our broken health care system, too, as do most Democrats running for office.  But when Obama told the stories, they were of his family.  He talked about his mother, spending the last few months of her too-short lives fighting cancer and insurance companies, who wanted to claim the cancer was a pre-existing condition.  And he talked about his grandmother, Mrs. Madelyn Dunham, who died shortly before he was elected president:

What I’ve learned from watching my grandmother is that with some modest help she’s able to remain independent.  And that costs the system much less than if she’d gone into a long-term care facility. The problem we have is that so much of our system is built around institutional care that we end up spending more money than we need to and probably with worse outcomes in a lot of cases.

These are not abstractions for me.

Not only that, but when Obama did the “Walk a Day in My Shoes” program through SEIU*, he walked through the daily routine of Pauline Beck, a home health care worker in Oakland, CA.  In what he often referred to as “one of the best days I've had on the campaign so far,” he lived the life of a home health worker and saw first-hand how much better off Mr. Thornton, the 87 year-old triple amputee, was being cared for in his own home.

After telling the story of his grandmother and his “Walk a Day” experience from sea to shining sea, there was ample reason to believe that Obama was truly a different politician, that he felt the issue in his bones.

Look, there’s no doubt our current national long term strategy is based on inertia rather than common sense.  For Medicare and especially Medicaid, long-term care too often translates to care in an institution – a nursing home, or a hospital.  This may have made sense 40 years ago when the programs were first introduced, but we have different choices now, both for the elderly and the disabled.  Yet according to the AARP, nearly 75% of long-term care allocation in 2006 were for institutional care – even for those who don’t need full instutionalization.  A friend of mine who only recently went on Medicare found this out the hard way.  She had complications from surgery and developed a staph infection.  After a too-long hospital stay just to be stabilized, Medicare would not pay for a home health worker to visit her once a day with the appropriate medication, but would pay for her to be institutionalized in a nursing home for two weeks during convalescence.  In terms of cost, it's absolutely no comparison -- she only needed the first, which was the cheaper option, but was forced into the most expensive option because Medicare wouldn't pay for her care otherwise.  It’s a vivid confirmation of AARP’s other stat:  “On average, Medicaid dollars can support nearly three older people and adults with physical disabilities in home and community-based services (HCBS) for every person in a nursing home.”

That’s bizarre and wasteful enough when we’re talking about seniors, but what about the disabled?  Why should you live your life in an institution because you have autism?  Or multiple sclerosis?  Or some other disability that renders you somewhat dependent on others, but otherwise wouldn’t prevent you from living your life at home and with the freedom that the rest of us take for granted?  It seems simple fairness to offer people a choice where there is legitimately no medical basis for institutionalization over home care.  Given that it also saves money in the system, it actually seems like a no-brainer.  It's what health care reform should be about -- greatly reducing costs and improving quality for those who need it.

Obama has talked the talk – but there’s only one way to get him to walk the walk for sure.  Write to your representatives and demand that Congress pass and the president sign the Community Choice Act.

*  (Full disclosure:  I work for CIR, which is a division of SEIU Healthcare).