THE LAST thing this country needs is more nursing homes. What's required instead is a shift in rules governing the billions of dollars the government doles out for long-term care of elderly and disabled Americans.
A nursing home may charge residents up to $60,000 a year. Yet they typically receive less than three hours of care a day, according to two University of Minnesota researchers, Robert L. Kane and Rosalie A. Kane.
All the while, nursing homes continue to expand, their lobbyists insisting that the need for beds will rise as the population ages. As the Kanes and other experts have noted, such claims lead to a self-fulfilling prophecy.
The Federal Health Care Financing Administration, which hands out Medicare and Medicaid money to nursing homes, gave them $20 billion in 1989. Medicaid legislation allows funds to be spent on what's called the personal-care option. Many experts note that, while institutional "care" costs an individual $30,000 to $60,000 a hear, the same level of care at home typically costs around $15,000.
But the health-care agency continues to finance programs that provide institutional care to the exclusion of home services, even though personal care has proved less costly.
Not to mention more appealing. "Nobody wants to live in a nursing home," says Wade Blank of Americans Disabled for Attendant Programs Today (ADAPT), a protest group. "That should tell us something."
ADAPT is calling on the secretary of health and human services, Louis H. Sullivan, to direct $5 billion of the current $23 billion away from nursing homes and into what it calls attendant services. Such a shift would allow people who need help to arrange their own care in their homes -- not medical care, but personal assistance, the kind that most disabled and elderly people need.
Simply recognizing that personal care is not medical and can be managed at home could save this country untold billions of dollars. Why doesn't it happen?
It doesn't happen because the nursing home lobbying group, the American Health Care Association, has convinced Congress, the Bush administration and the American public that such "care" is fundamentally medical, allowing the industry to continue to provide it -- in its institutions, of course.
This is absurd. What's "medical" about helping someone wash, eat and change his or her clothes?
Those opposed to changing the system say that if Medicaid financed such in-home help, the system would be overwhelmed with requests for such aid -- even though everyone admits that home care is less costly per person. But what kind of argument is this? It admits that he replacement of the current system will be so much more humane that many more people will want its services.
The Kanes are on to the nursing homes' scams, questioning many so-called professional practices. "The current orthodoxy and rules for licensure have generated an expensive form of professionally based services," they wrote in an editorial in the Feb. 28 issue of the New England Journal of Medicine.
Indeed. Some nursing homes charge residents up to $200 a day for their so-called services. At those prices, you should expect nonstop entertainment, catering from the Four Seasons, saunas, massages and personal trainers -- and an occasional outing to London or Paris.
Instead, the $200 is typically charged for the more modest "service" nursing home residents all too often endure: lying in their own waste all night; getting dressed only when the staff wants them to; being tied to a wheelchair and pumped full of drugs to keep them quiet; rolled into an out-of-the-way place to watch nurses' aides trot up and down the hall with dirty laundry and pills, while a TV blares somewhere off in the distance.
Isn't it time the government called nursing homes on the carpet -- not just for poor care but for abusing public funds?
Mary Johnson is editor of The Disability Rag, a publication that covers disability rights issues.