NPR continues its series on the ongoing struggle for people with disabilities and the elderly to receive care in the community rather than in nursing homes. Particular attention is given to working-age adults and children who are forced to live in nursing homes because states–many in the South–provide little or nothing in the way of community-based supports to enable them to stay at home. One of the stories quotes Carol Steckel, a former Alabama Medicaid director, who explains states’ continued reluctance to offer home and community-based services:
At a meeting of state Medicaid directors, in a hotel outside Washington, D.C., last month, Steckel noted many reasons states are reluctant to expand home-based care. How do you make sure people get good care at home? It’s easy, she says, to send an inspector into a nursing home. It’s harder to check on hundreds of individuals in their own homes.
And then there’s the money question. It’s a big problem for states facing all-time-high budget deficits.
“We’ve got people asking us to do 24/7 at-home care,” she says, “which means that we’ll be paying $500,000 for one individual. And then you have to debate as a society is that what we want to do versus taking that $500,000 and spending it on prenatal care for 10,000 women. I mean it’s a societal question, it’s a conundrum almost.”
With former bureaucrats like Steckel espousing such paternalistic and alarmist bullshit, it’s little wonder that people are still languishing in nursing homes. States are certainly facing significant budget deficits, but in most cases care can be delivered in the home for much less compared to a nursing home. And plenty of people already receive great care at home. Perhaps Steckel should pay a visit to Minnesota to see how it’s done.
