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Guest Opinion
Must The Elderly Be Driven To Destitution Before
The Government Recognizes Their Need For Help?
 By
Jewel Littenberg
Senior Advocate, TV Talk Show Host
of "Issues, Answers and More... With Jewel" T.E.N., The Education
Network, Palm Beach, Florida, and former fashion designer (more
about Jewel at bottom of article)
Nov. 5, 2004 - According to a recent report from
the Family Caregiver Alliance, the fastest growing population
group in the country, most in need of long-term care are the very old...
age 85 and older. This age group is expected to reach 8.9 million
persons in 2030. Based on these statistics, there's also a good chance
that even if you remain fairly disease-free, you will eventually need
care. Would you choose remaining in your own home or institutionalized
in a nursing home?
Many nursing homes offer excellent care. And
unfortunately, some patients require levels of care that can only be
administered in a nursing home. However, when given the choice and the
circumstances permit, most prefer remaining in their own homes.
Only when I became the primary caregiver for my
late father, did I give this decision much thought.
My parents were not wealthy people. They had been
farmers, products of the depression. In the course of their sixty-five
years of married life, they provided for six children, siblings, elderly
parents, and often were charitable to the less fortunate.
Not long after my mother died, my dad began to need
care. A few hours a day soon evolved into twenty-four hours the last
seven years of his life. Since his minimum social security payment was
not enough to cover his caregiving needs, and his savings were rapidly
becoming depleted, I began to seek assistance.
My quest for information became a bureaucratic maze
that I was forced to endure by spending untold hours which spanned into
months of telephone calls just to prove to the government that my father
was in need of financial help.
I learned that, although it may vary in certain
states, if my father had more than $2,000 in assets, very little
financial assistance was available. Once his assets fell below $2,000,
his destitution would entitle him to be placed in a nursing home on
Medicaid, the government health care program for the poor. Since many
facilities limit the number of beds available to Medicaid patients,
simply because private-pay residents provide a greater revenue, this
often creates a waiting list. Therefore application needs to be made
months in advance. In addition, a private-pay patient will enjoy more
options than a Medicaid patient.
According to Brian Payne, Ph.D, and author of the
bestseller "Crime in the home healthcare field", "for many
elderly persons, in-home care is much more preferable than nursing home
placement. The advantageous of in-home care are numerous. By staying at
home, individuals retain a sense of autonomy and this autonomy increases
their quality of life and their physical well being. For society,
in-home care can be delivered at rates far below those rates found in
nursing home care. One of the drawbacks for consumers, however, is that
the costs of in-home care are not adequately supported by state or
federal governments. In the end, consumers may often avoid this option
because of the lack of funding available to help them access home health
care".
A recent report on nursing home care by the General
Accounting Office (GAO) found frequent cases of neglect; patients were
left unattended for hours, their diapers were soiled, and their calls
for water were ignored. In a report by The Commonwealth Fund, at
least a third of the 1.6 million nursing home residents in the United
States suffer from malnutrition or dehydration which is attributed to
understaffing. Typically, one certified nursing assistant (CNA) must
help seven to nine residents eat and drink during the daytime, and as
many as 12 to 15 during the evening meal. Ideally, according to the
report, the ratio should be one CNA for every two to three residents.
After speaking to several Florida home healthcare
school administrators, I learned that a Certified Nursing Assistant
requires less training than a nail technician. In my opinion, this is
simply unacceptable considering that the CNA's are the ones
administering most of the care in the homes and healthcare facilities.
As I became more involved with my father's care, I
became convinced of the necessity for change in the way our government
assesses the needs of our elderly. If you were rich, no problem. If you
were poor, there was Medicaid.....even if it meant being put on a
waiting list. But what was our government doing to prevent all the other
millions of elderly from falling between the cracks?
Walking in the shoes of a caregiver, my feet were
badly hurting. Through my father's needs, I could sense the desperation
of the needs of all the other elderly who had nobody to speak for them.
How could our government force the elderly... the generation who fought
for this country, and paved the way for the young.....to destitution
before it realized their cries for help? What was going to become of us,
our children and grandchildren? Using my father's needs to guide me, I
proposed federal legislation for change.
In July 2002, after three years of hundreds of
phone calls, letters and speeches asking for government funded
in-home care for the elderly, my proposal became a bill. Introduced
to the U.S. House of Representatives for federal legislation by U.S.
Congressman Alcee Hastings it is now on the Health Subcommittee. The
bill asks for federal legislation to provide up to twenty-four hours of
in-home care as an alternative to nursing home placement; better
training for the healthcare workers; and better supervision of the
caregiver. (To read bill go to
jewelshow.us.)
Many of us are familiar with Nancy Reagan's vital
role as caregiver to the late president during his long Alzheimer's
illness. Not only did she choose to keep him at home, her overseeing was
vital to his quality of care. Although most of us are not entitled to
the healthcare benefits President Reagan and other former and current
elected officials are, once a caregiver is employed, supervision is
paramount to quality care.
There are an estimated 44.4 million Americans,
including children, providing unpaid care to another adult. 78% of
adults receiving long-term home care rely exclusively on family and
friends to provide assistance. In addition to full-time jobs outside the
home, these unpaid caregivers contribute $257 billion in services and
support...more than double the annual spending on home care and nursing
home care combined. Not to mention, their loss of pay, jobs, and missed
opportunities for job advancement. In a recent report "The Effects of
Family Caregiving on the Education of Middle School Students With Family
Health Issues" by Constance T. Siskowski, Ph.D, the academic
performance of 37.6% students in grades 6 through 8 in Palm Beach,
Florida was affected as a result of their caregiving responsibilities at
home.
Although some seniors have long term care
insurance, most do not. Cost, being the most important factor. Depending
upon age, a typical premium for a policy that covers a $100 daily
benefit ranges from approximately $850 to $5500 annually. And, like all
insurance, long term care insurance policies contain limitations and
exclusions.
Some states have Medicaid waiver programs which are
used to pay for in-home care and other community based programs.
However, because funds are limited, there often is a wait-list. And,
when a frail elder has no more than $2,000 in total assets, how long can
he afford to wait for food and care?
The Kaiser Foundation reports that most
states are concerned that budget pressure to control Medicaid spending
will continue at an intense level for 2005. And, that Medicaid policy
makers will continue to face difficult challenges for some time to come.
In June 1999, the United States Supreme Court
issued the Olmstead ruling, which basically is about choice.
It is the choice given to people with disabilities of receiving
long-term care and treatment in an institutional setting or in a
community setting. Unfortunately, especially when it comes to our
elders, not all states are complying with this decision. Many of our
loved ones are being institutionalized in nursing homes, when they need
not be.
Our government appears to be moving in the
direction of making home and community-care options more readily
available. But, they must also provide the necessary financial resources
so that our elderly can remain in their own homes and continue to be a
valuable part of the community. Paid caregivers are costly, which most
elderly cannot afford. By not providing financial supplementation, the
government is compounding the problem by creating longer Medicaid
waiting lists.
We must send the message to our elected officials
that "as there was dignity in our contributions when we were young, we
should be granted the same dignity in times of our declining health".
Although my father depleted all of his financial
resources, we were able to keep him in his own home, with excellent
care. He died one month short of his 98th birthday, soon after my
resolution became a bill.
I became an advocate when the needs of my parents
made me aware of the needs of other elderly. We all must become
advocates; not only for our own needs, but for the needs of our children
and their children for generations to come.
More About Jewel
Prior to becoming an
advocate for seniors, Jewel's career was that of a fashion designer.
Born in Rochester, New York she obtained a Fine Arts Degree from the
Rochester Institute of Technology, and a degree in Fashion Design from
the Traphagen School of Fashion in New York City. It was there that she
established herself as an award winning fashion designer before moving
to the West Palm Beach area in 1973, with her husband and young son.
Shortly after she created a wholesale sportswear clothing business,
Jewel of Palm Beach, which she operated for 23 years while selling
to stores worldwide. It was during this time she was selected for
inclusion in the Fifteenth Edition of Who's Who of American Women
placing her achievements amongst those of Rose Kennedy, Barbara Walters,
Sandra Day O'Connor and so many other women of accomplishment.
In 1992, she was
introduced to the world of caregiving, when her mother suffered her
first stroke, and died two years later. However, it was the result of
her father's needs that began to surface a few years later that made her
realize how many thousands of elderly were facing the same challenges,
and had nobody to advocate for them. It was at this time, she decided to
retire from her business and spend the remainder of her father's life
taking care of his needs, as well as advocating for the needs of others.
As a result, she wrote a resolution asking for "government funded
in-home care for the elderly" which provides the option of remaining in
one's home, as opposed to being forced to be institutionalized in a
nursing home. The resolution became a bill when it was introduced to the
House of Representatives by Congressman Alcee Hastings in July, 2002.
Jewel, a well known
advocate for the elderly, has written numerous articles on caregiving
and is a sought-after speaker by many groups and organizations. In
addition, she created and hosted an advocacy talk radio show Issues
and Answers with Jewel, heard on Radio. Jewel created this show not
only for the purpose of providing the latest information by a panel of
experts on issues such as discount prescription drug plans, nursing home
abuse, in-home care, etc., but to give the listening audience the
opportunity to be heard. The Radio show has since moved to television,
on Channel 19, T.E.N.
Jewel hopes her legacy will be that of her parents — to have made a
positive difference in the lives of others.
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