Dignified Care for the Elderly

AMZIE is an 86-year-old woman who Alives in a senior citizen apartment complex in Tallahassee, Fla. She has been diagnosed with several health problems. Still, with a limited amount of outside assistance, she has managed to maintain her apartment and her independence.

The key to Amzie's continued well-being is community-based, long-term care that helps senior citizens remain independent if they begin to lose their self-sufficiency. Under the Florida Department of Elder Affairs' community-based program, Amzie receives Meals on Wheels each day, homemaker services twice a month, and transportation to and from doctors' appointments. She is one of the lucky few. Most states do not offer a comprehensive array of long-term care services, and Florida's program reaches less than 15 percent of the 600,000 Floridians over the age of 60 who require help. As the elderly population increases, the need for a national long-term care program is becoming more urgent. Such care should provide the elderly with at-home care and provide nursing-home care if they no longer can function at home.

By offering the elderly increasing services as their needs grow greater, a comprehensive long-term care plan would help more senior citizens remain independent and save the cost of unnecessary institutionalization.

Current federal health-insurance programs do not provide the comprehensive coverage desperately needed by the nation's elderly and disabled citizens. Medicare covers just 100 days of convalescent care in a nursing home following an acute illness, and even that limited coverage requires the patient to contribute $84.50 a day after the first three weeks.

Since Medicare offers such a limited benefit, most of the nation's elderly have to fend for their own long-term care needs. These senior citizens often exhaust their resources, become impoverished, and then qualify for Medicaid, the health program for the medically indigent. Because Medicaid, like Medicare, normally does not pay for at-home, long-term care, these people are prematurely forced into nursing homes, which cost up to twice as much as home- and community-based care. That means not only a loss of independence for the patient but a greater burden on the taxpayer as well. If we continue along this course, the nation's long-term care problem will deteriorate. Without a comprehensive long-term care program the needs of the elderly will soon overwhelm the federal government, bankrupting Medicaid funds and compounding the deficit.

President Clinton's health-care reform package takes the first steps toward a federal long-term care program. As Congress debates his plan, we must focus on how to address three essential facets of our nation's long-term care needs.

* We must provide a network of support for senior citizens early, not when they are on the verge of collapse. If the standards for community-based care are too stringent, help may come too late for many senior citizens.

* Long-term care must go beyond purely medical services. Effective community-based long-term care means providing the elderly with social services as well.

* For those senior citizens who require institutional care, the current policy of forcing nursing-home residents to impoverish themselves before they qualify for help is undignified and economically inefficient. A comprehensive plan must include assistance not just for community-based care but also for those elderly who require the comprehensive care of a nursing home.

The president's health-care reform plan would ultimately save money and allow the elderly to age with grace and dignity.

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