A better way to assist US elderly poor

Just a few blocks from one of Miami's glittering downtown streets, Catherine Dowling has been living alone in a cheap hotel room furnished with only a bed, table, chair, sink, hot plate, and small refrigerator. On a recent day her refrigerator contained only a stick of butter, an opened quart of milk, some cheese and jelly, and a sandwich in a brown paper bag.

"Regrettably," says Jack Ossofsky, executive director of the National Council on the Aging, circumstances such as Miss Dowling's are "not terribly unusual" among the nation's 3.3 million elderly poor (65 or older).

But a new federal strategy is developing that would offer more of the elderly poor the help they need.

Often not in close contact with other family members, often too proud to seek help or unaware of help that is available, many of the elderly poor suffer alone , Mr. Ossofsky says. For those who do seek help, nursing- home care is often the most readily available because the vast majority of federal aid for the elderly goes to nursing-home care.

But only about 5 percent of the elderly live in nursing homes, says US Rep. Claude Pepper (D) of Florida, chairman of the House Select Committee on Aging, and about one-fourth of these do not need the full services offered in a nursing home. Furthermore, many persons are eligible for medicaid only if they live in a nursing home. "Practically speaking," Representative Pepper says, "they have no options."

So the new federal strategy he and others are supporting is a shift of some of the massive amounts of government funds for nursing-home care (about $6 billion a year now) to other kinds of help, such as homemaker services, transportation, and home health care. Such help, already available on a limited scale compared with the need, would enable more persons to live more independently than in nursing homes. And, since such assistance is much less expensive per person than nursing-home care, more of the elderly could be helped without increasing current spending.

The aim of such a shift: "a system that glorifies the home rather than the hospital or nursing home," says Representative Pepper, whose district includes most of Miami.

Mr. Pepper and Rep. Henry Waxman (D) of California recently introduced legislation that would offer a state increased matching federal medicaid funds if that state makes greater efforts to provide alternatives to nursing home care for the elderly. Also recently, a House and a Senate committee have reported favorably on bills to make home health and other home care more available under medicaid and medicare programs.

Eventually, if alternatives to nursing home care were made widely available, the total bill to taxpayers could exceed the cost of nursing-home programs, some planners point out. And there is some reluctance in Congress to spur a giant home-care industry that might involve some of the same abuses that have arisen in the government-spurred nursing home industry.

Meanwhile, many elderly poor are caught in a bind, Mr. Ossofsky says. Even where non-nursing-home help is available, the elderly often are unfamiliar with how to get it. He recommends more door-to-door contact with the elderly by groups like Operation Mainstream here in Miami.

Operation Mainstream, funded by city and private donations, offers counseling to the elderly and helps them find suitable places to live.

Social worker Rona Bartelstone of Operation Mainstream, who responded when Miss Dowling called for help recently, estimates there are about a thousand elderly persons in downtown Miami needing help. And, like Miss Dowling, they often live in run-down apartments or hotels, she says.

Leaders of many programs for the aging, however, are afraid to do much looking for those in need for fear of overcrowding small programs run on limited budgets, one national advocate says.

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