Nobody Wants to Live in One

May 01, 1991|By MARY JOHNSON

HORTONVILLE, NEW YORK — Hortonville, New York. The average nursing-home resident receives less than 3 hours of care a day. That's what Robert L. and Rosalie A. Kane of the University of Minnesota School of Public Health wrote in a February 28 editorial in the New England Journal of Medicine.

The federal Health Care Financing Administration, which doles out Medicare and Medicaid dollars to nursing homes across the country, gave them over $20 billion last year. These institutions charge up to $60,000 a year for a resident's care -- three hours' worth a day, as it turns out.

That's potentially over $50 an hour -- a mighty expensive fee for the kind of care the typical nursing-home resident gets: a chance to lie in your own waste through the night, getting dressed only when nursing-home staff -- not you -- choose; getting tied into a wheelchair and pumped full of drugs to keep you quiet; rolled into an out-of-the-way place in the hall to watch nurses' aides trot up and down with dirty laundry and pills, as a TV blares somewhere in the distance.

What kind of care could that resident get if she could use that $50 an hour -- $150 a day -- and hire somebody herself?

Long-term care reform advocates point out that the same level of care -- better, in most cases -- can be had in one's home for around $15,000 a year -- a fourth the cost of a year in a nursing home.

Isn't it time somebody called nursing homes on the carpet -- not just for poor care, but for stealing public funds?

The American Health Care Association, the nursing-home lobby group, has somehow convinced Congress, the administration and the American public that ''care'' is fundamentally a medical procedure and therefore ''trained professionals'' must provide it -- in their nursing homes, of course.

That's an absurd idea, once it's examined. What's so ''medical'' about helping someone wash, eat and change clothes? The care most people in nursing homes need is like the kind of care the valet or lady's maid provided the well-off in years gone by.

''Nobody wants to live in a nursing home,'' says Wade Blank of American Disabled for Attendant Programs Today (ADAPT). ''That should tell us something.''

ADAPT is telling the Health Care Financing Administration something this week -- something it doesn't want to hear. The shock troops of the disability-rights movement, ADAPT's hundreds of activists, who have been compared to the AIDS activist group Act-Up, are in Baltimore this week, chanting, picketing, protesting and, if necessary, getting arrested.

They want the Health Care Financing Administration to redirect $5 billion from nursing homes into ''attendant services.''

Attendant services is a simple concept if there ever was one: A person who needs help with personal care hires his own helpers, in his own home. Not medical care -- personal assistance.

It would cost this country no more money. It's merely a redirection of funds.

Will it happen? Not without a fight. Nursing homes are businesses. They don't want to lose revenue. So they fight hard to retain their hold on the public dollars. How much longer can they succeed?

Mary Johnson is editor of The Disability Rag, which covers the disability-rights movement.

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