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Respecting Our Elders

Elderly Americans are the fastest-growing segment of our nation's population, yet Louisiana -- like much of the country -- continues to treat them as second-class citizens.

U.S. Sen. John Breaux has taken steps to address this ignominy through a wide-ranging federal bill that would establish a stronger safety net to protect this vulnerable and often-abused population. Breaux's bill proposes creating two federal "elder justice" offices, as well as supplemental centers to provide research and training. The training would include programs ranging from geriatric education for health-care professionals to instruction for bank employees to help them recognize when a senior citizen's account is being suspiciously drained.

Additionally, the bill calls for FBI background screens for all employees and contractors of senior care facilities accepting Medicaid or Medicare. The legislation would also mandate that police -- not just local health departments -- be notified when a crime is committed against a resident of a long-term care facility and includes financial incentives for programs designed to improve the quality of care for senior citizens.

We applaud the legislation and encourage Louisiana's congressional delegation to support it. But the federal bill is only half the battle; the state of Louisiana must also do its part. Simply put, Louisiana does not provide enough home-based and assisted-care options for the elderly and disabled. As Breaux has pointed out, Louisiana ranks last in providing senior citizens with care choices other than institutionalization. While other states are adopting more flexible and holistic home- or community-based options for seniors, Louisiana is bucking national trends by continuing to divert the majority of its Medicaid funding to nursing homes, rather than home- or community-based care.

Earlier this month, Department of Health and Hospitals secretary David Hood told the House Appropriations Committee that Louisiana ranks third in the nation for the rate of nursing home beds per capita, but provides home and community-based services to less than one percent of the people who qualify for them. And, according to DHH, only 78.7 percent of Louisiana's nursing home beds are actually being used. "We are overbuilt and under capacity," says DHH spokesman Bob Johannessen. "We are funding nursing homes at the expense of not funding personal care attendants, assisted living and other options that people today say what they want."

Basically, Louisiana is sending its Medicaid money to nursing homes whether people are in them or not, instead of supporting reasonable, practical and humane home- and community-based care options. DHH is lobbying the Legislature to approve more Medicaid waivers for home- or community-based care. Its plan proposes a reallocation of Medicaid funds based on what citizens want and what makes fiscal sense, says Johannessen. Common sense dictates what national and international studies have shown: that the elderly and disabled fare better physically and psychologically when cared for in their own homes, or in a group setting, rather than in an institution.

"The suggestion that is being made is that we are trying to shut down nursing homes," says Johannessen. "This [proposal] is based on what we know can create better health outcomes.

"Anybody who would argue that the status quo is the way to continue funding health care in Louisiana is blinded by the fact that we continue to rank 49th and 50th on all health indicators," he says. "The status quo has not produced proper and good outcomes."

We urge our state legislators to approve more Medicaid waivers for home- and community-based care and to buck pressure from the politically influential nursing home lobby, which has repeatedly tried to shut down efforts to offer alternatives to institutionalization for the elderly and disabled.

Some legislators, happily, support DHH's plan. Sen. Jay Dardenne, R-Baton Rouge and vice-chairman of the Joint Legislative Committee on the Budget, is one. "It represents a wise new course that DHH is embarking on," Dardenne says. "The long-term objective would be to make better use of taxpayer dollars by directing them toward care that would be more economically wise for the state and more beneficial for the recipient."

It is worth noting that flexible care options are not just sound policy; they comply with a landmark 1999 U.S. Supreme Court decision requiring states to provide services "in the most integrated setting appropriate to the needs" of the elderly and disabled.

According to the U.S. Department of Health and Human Services, 35 million Americans -- that's one in eight -- is 65 or older. By 2030, there are expected to be 70 million senior citizens in America. The way to deal with the aging is not to shut senior citizens away in nursing homes, but to adopt more flexible, fiscally sound and compassionate policies regarding their care. Nursing homes may currently be the only option for many elderly people, but this rapidly growing population deserves other choices. It's time Louisiana began offering them.

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