Making People Disappear
I ask the elderly woman who is moving about a house that has seen better days, if she needs help with getting in and out of the shower/tub. She gets around slowly, painfully, with a walker and is lucky to have a neighbor who comes over to help with getting groceries and paying bills. Right now, she gets assistance in the form of a housekeeper a few hours a week, a nurse once a month to review her medications and assess any concerns, and someone to take her to medical appointments. This, she feels, is all she needs to stay in her home. Having this minimal service does more than keep the house decent and her health stable, it provides eyes to see problems and ears to hear concerns, there is a large social component these providers bring with them. Additionally, her case worker is very pro-active in searching out services that help to maintain the home and remedy hazards.
The woman describes, in detail, how she manages her daily hygiene, medication administration, dressing and grooming. The work is slow, difficult, not without risk of falling or otherwise being injured. But she does not want help with this. She is proud of her ability to care for herself. She is doing what most of us would do; all she can, letting go of the less intimate tasks first in order to maintain control of her own body.
The problem? Now, with the new state regulations, she will no longer qualify to receive a housekeeper or transportation to appointments, or any other services. In order to qualify, she needs to be at the same level of care considered appropriate to long term care nursing home placement; which means first of all she needs to be dependent in more than one (I think it is three) “medical” areas of activities of daily living. Bathing, dressing, walking, getting in or out of bed, or taking medications. Once she qualifies there, then the housekeeper, nurse etc can follow.
The rationale is that Medicaid is a Medical program.
The result is a system that is reversed in a way that results in making the disabled or elderly who struggle to maintain independence “disappear”. They no longer qualify, they are no longer part of the budget, counted among those who need help to remain independent in the community. This also sets people up to fail, to deteriorate, to lose what they have worked hard to earn, and, most sadly, perhaps to die alone and forgotten by preventable causes. Those fortunate enough to have involved friends, family or church/social networks may continue to be served. Others will be neglected and, as far as I am concerned, this should be criminal neglect. The stated agenda is to foster independence, the real agenda is to save money at the expense of the weakest, least likely to complain among us.
Some towns are being creative, in one the police provide medical transportation and check in on their elders. This came about, I am told, because the police chief had an elderly mother, saw the problem, and got his staff involved. It is a nice town to be older in, but it is unreasonable to expect localities to handle all of the challenges that an aging population present. As a society, we need to take care of those of us who cannot take care of themselves to the extent that the help is needed. It means paying people adequately to provide help in addition to maximizing use of informal assistance.
