Is receiving care at home a civil right?

  1. 5
    I noticed this story on NPR's website this evening. http://www.npr.org/2010/12/02/131751...ew-civil-right. Given the aging of the boomers, it examines an issue that has the potential to affect nearly all of us in one way or another in the not-too-distant future: Is it your civil right to receive health care at home, rather than at a nursing home?

    "The Americans with Disabilities Act — ADA — is a 20-year-old law that bans discrimination on the basis of disability. Eleven years ago, the U.S. Supreme Court ruled in Olmstead v. L.C. that people who live in institutions like state hospitals and nursing homes but could live successfully on their own have a civil right, under the ADA, to get their care at home.
    Since then, federal policy was updated in the recent health care overhaul, which says that states need to spend more money on Medicaid programs for people to receive their long-term care at home.
    But federal law requires states to pay for nursing homes, while community-based care programs are optional. So as states face record budget gaps, they only slowly add, or even cut, programs designed to help elderly and disabled people live at home."


    The article is interesting and raises a number of issues, such as how to inspect homes for to be certain good care is being provided, as well as the matter of the costs involved (though several studies have shown at-home care to be less costly than nursing home care).


    Any thoughts?
    VickyRN, sharpeimom, blondegenes, and 2 others like this.
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  5. 0
    Generally speaking, the thought for people with disabilities is that they are to receive care "in the least restrictive environment". Most of the time, ideally, that is in their home, or their home community, however, medical needs or lack of care available, may mean that the least restrictive environment has to be a facility of some sort. Any time there is talk of disability, etc., there will always be that "least restrictive" component. I have an adult daughter who is severely disabled and medically fragile, so this is an area that I have some knowledge on. Don't think it is a "civil right" so to speak.
  6. 2
    The supreme court, from their lofty perch, can make any ruling they choose. The difficulty lies, as in all areas of nursing, to find enough staff to safely carry out that mandate. There are not enough home care nurses or ancillary staff to make it possible, and I have only very rarely seen any of the insurance companies pay for 24/d care at home or even 12hr/d unless there are skilled needs that warrant a nurse to be with the patient that many hours/day. Generally, that isn't the case, and insurance companies (medicare and medicaid included) aren't going to supply 24 h/d personal care aides to make sure that the patient doesn't wander away from home, or set the house on fire, or ingest things not meant for human consumption, or for toileting. That means the "burden" falls on the family. It's great to go into a home, do an admission, and set up a plan of care. Two weeks later, when there are sick calls that the agency can't cover and the family is unwilling or unable to step in, the patient will end up in an institution anyway...unless the Supreme Court also decides that it's also the patient's right to stay at home unattended and perhaps unsafe. The shortage of nurses and ancillary health care staff needs to be addressed nationwide. Without fixing that underlying problem, it won't make any difference what the Supreme Court rules because there won't be enough staff to actually make it happen. Of course, they can always fall back on the phrase that I hear way too often anymore, "Just do the best you can." Just because it's my best and my co-workers' best, doesn't mean the patient doesn't deserve better.
    nursemarion and S.N. Visit like this.
  7. 0
    Is the answer really "do the best you can", or is it "we know you can't do it but do it anyway. Then whenever someone decides to make an issue of the fact that you are not doing it, for any reason, we will prosecute or at least fire you"?

    That is actually not meant to be a flippent question, although I think it may look like it is.
  8. 0
    And, Saysfaa, you are absolutely correct! At this point, having heard that same directive in ICU's at community hospitals & major trauma centers, in home care, and in skilled nursing facilities, I am in the process (after 35 years in nursing) of retraining to get the heck out.
  9. 0
    Quote from old lady
    The supreme court, from their lofty perch, can make any ruling they choose. The difficulty lies, as in all areas of nursing, to find enough staff to safely carry out that mandate. There are not enough home care nurses or ancillary staff to make it possible, and I have only very rarely seen any of the insurance companies pay for 24/d care at home or even 12hr/d unless there are skilled needs that warrant a nurse to be with the patient that many hours/day. Generally, that isn't the case, and insurance companies (medicare and medicaid included) aren't going to supply 24 h/d personal care aides to make sure that the patient doesn't wander away from home, or set the house on fire, or ingest things not meant for human consumption, or for toileting. That means the "burden" falls on the family. It's great to go into a home, do an admission, and set up a plan of care. Two weeks later, when there are sick calls that the agency can't cover and the family is unwilling or unable to step in, the patient will end up in an institution anyway...unless the Supreme Court also decides that it's also the patient's right to stay at home unattended and perhaps unsafe. The shortage of nurses and ancillary health care staff needs to be addressed nationwide. Without fixing that underlying problem, it won't make any difference what the Supreme Court rules because there won't be enough staff to actually make it happen. Of course, they can always fall back on the phrase that I hear way too often anymore, "Just do the best you can." Just because it's my best and my co-workers' best, doesn't mean the patient doesn't deserve better.
    I guess the point is, if home care becomes a recognized and valued civil right for much of the U.S. population, revamped funding may well soon follow. The boomers are caring for aged parents and have entered or are bordering on their senior years. We're seeing much more interest in home care; it seems likely that political pressure might mount behind an effort to secure a different funding structure for home care. If more money flows to home health care, nursing positions will be created to provide that care. A judicial ruling doesn't automatically change everything, but paired with major political pressure from seniors (who vote and have a very powerful lobbying group in the their corner) on their legislators, the entire current scenario could easily change. Nursing homes haven't been in existence for all that long; home health care could become the accepted norm. Where the money goes, the staffing follows; if federal funding is redirected to home health care, the necessary hiring will soon take place.
  10. 2
    If the federal and state authorities stopped funding home care in lieu of institutions for all of those that receive it, I would be out of a job permanently. Of course I support home care, it is my bread and butter, with a glass of milk here and there.
    Not_A_Hat_Person and tewdles like this.
  11. 0
    I do not believe that home care would stop receiving funding. The state I live in - Wisconsin, has been pretty progressive on trying to stop institutional placement of people with disabilities in lieu of group homes, etc. One very large institution was completely shut down a few years back, with all the residents going to group homes, etc. Of course, there are always going to be those really hard to place people that probably will always need institutional care. People who are the most severely disabled (minus mechanical ventilation), cost over $100,000 per year in institutional care costs, so states are really hoping that by placing someone in the community - a group home for instance, that the costs will be much less.

    Also in our state, there have been a couple of programs that have been launched recently specifically to address the adult population of elderly and disabled who are in need of care. It hasn't been perfect, but hopefully the programs will offer some good alternatives to nursing home and institutional placement.

    I see this as a huge issue, not only because of nursing home or home care needed for seniors, but with neonatal advancements, smaller and sicker preemies are being saved (sort of) and many of these salvaged neonates are ones ending up with severe issues that will require life-time care. A whole new population that prior to about 30 years ago, really didn't exist. .now it is exploding. Another consequence of advancements in medical technology, unfortunately.

    I'm also in home care - providing care for 2 pediatric clients who require 24/7 nursing care. I cannot imagine funding being cut for these clients, as the families would really not be able to manage all of this alone. The state is saving $$ by paying for some in-home RN care to help these families keep their children at home vs the cost of institutional placement. Let's hope anyway, that they will continue to see the value in what we do.
  12. 1
    Isnt this the reason there is "source" and "ccsp". Isn't the idea to help patients stay in the home, it is cheaper. Back in the day, I was a supervisor for ccsp in the late 1990's. If memory serves, they pay a stipend of $1000/m per patient. The idea is you send cna's into the home to help with bathing 2-3 times a week, and have an RN as a supervisor make a visit every 90 days.

    I don't think healthcare is a right, it is a service. Surely if this lady got meals on wheels and had assistance bathing 2-3 times a week, she could live at home???

    If home care is a civil right, WHO is going to pay for it???
    DC Collins likes this.
  13. 0
    here is the link for georgia source program.....it must be funded by medicaid?

    georgia.gov - Department of Community Health


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