Friday, October 14, 2011

Money Follows the Person

Imagine having to ask permission to change your address, go to a movie, or take a walk outside alone. For thousands of people with disabilities living in a nursing facility, this is the reality. But new home and community-based programs across the country are changing these systems that have made it nearly impossible for people to avoid long-term stays in care facilities like nursing homes once they’ve entered.

In a nationwide effort to help states remove barriers to community living for people with disabilities, President George W. Bush’s 2001 ‘New Freedom Initiative’, is putting funding where it needs to be. One initiative, the “Money Follows the Person Demonstration Grant” (MFP) allows states to use Medicaid funding intelligently, by helping people voluntarily move out of institutions and move back into their communities. MFP outreach staff work with facility staff and nursing home residents who want to explore community re-entry, in order to identify cost-effective alternatives to institutional care and help facilitate connections to specific programs that will meet the residents’ care needs within their community. By helping to move individuals from institutional settings to the community, states receive enhanced Medicaid funding while at the same time allowing individuals to achieve an improved quality of life.

According to Lisa Mastracco, the MFP Outreach Specialist for the Resource Center for Independent Living, one of the biggest boosts for residents is “learning that there are community care options and independent living programs they never knew about.” Lisa notes that many nursing home residents she meets with wish that they had known about these community programs before they were admitted to nursing facilities.

When institutional discharge planning is attempted, physical barriers that prevent individuals from returning to the community become apparent. When leaving facilities, many nursing home residents must consider what types of services they may need. Some individuals will need personal care and shopping assistance, others may need ramps to regain access to their homes, or other more complicated modifications to allow bathroom and kitchen access. For many individuals with disabilities, the lack of affordable and accessible housing is an additional barrier to community living that can lead to institutional placement. If families, social workers, and discharge planners are unaware of all the programs available that can collectively work together to enable a safe return home, institutional placement becomes the only health care approach. Institutions can be unnecessarily expensive and they remove people from family, and friends, and from participating in the mainstream of life, simply because disabled individuals need some home based assistance within their communities.

Since the start of the MFP program statewide in 2008, hundreds of nursing home residents, facility care staff, and long-term care ombudsmen have been given information and advocacy assistance to enable transitions back to the community. One lesson taken from New York State’s MFP outreach program is that the earlier individuals can be identified, the better. The federal Affordable Care Act offers states that choose to continue to use this grant an extended round of MFP funding to reach even more eligible residents. Making the decision to leave a home or apartment, pack up household treasures and enter a nursing facility is traumatic for most people. Additionally, once the decision has been made to enter a facility, the prospect of transitioning back home is often too overwhelming for many residents even if they could be assisted safely in their homes. Nursing facility diversion is a crucial step in assuring that individuals not needing a nursing level of care get the support services and advocacy they need when they need them.

It has been noted that as of July 2010, 9,000 individuals across the United States have returned to their communities as the result of the MFP Outreach Programs. On average, community-based care is one third the cost of nursing facility care and with the Medicaid program serving even more needy individuals during the current economic downturn, spending tax dollars wisely couldn’t be more important. Providing the appropriate care setting is not only a legal mandate for individuals with disabilities, it is a constructive public policy approach to healthcare.

- Kate F.

Tuesday, October 11, 2011

Get your democracy on!

On November 8, 2011, polling sites across New York State will open so that voters can elect representatives to a number of seats ranging from Supreme Court judge, mayor, and state representative to name only a few. In Utica, the mayor’s seat is being sought by five local candidates who each believe they can make the city a better place to live. To help voters understand each candidate’s position on local issues, RCIL and the Utica/Rome League of Women Voters will be holding a candidates forum on October 27 from 7:00 to 8:30 p.m. at the Dorothy Smith Advocacy Center on Genesee Street in Utica. The community forum represents a chance for residents to pose important questions to candidates whose leadership will affect our everyday lives for years to come. According to Donna Gillette, RCIL’s policy analyst, “the candidate forum is akin to a town hall meeting where residents come together to exercise their political and social power”. Gillette notes that communities cherish these local races because they give the opportunity to be part of real “hands-on” governance since city officials are typically more approachable and accessible and often live right in the community where the race is taking place.

Once at the polls this year, all voters will be using paper ballots and ballot scanners to cast their votes as the entire state has made the switch from old lever machines as mandated by the Help America Vote Act. The paper ballots can be used easily by voters with disabilities. Even those individuals who typically need assistance with paperwork through a ballot marking device at each site can cast private and independent votes. College students can also vote in their college communities and are encouraged to do so as issues of transportation, the environment, safety, and taxes impact their college experience to a great degree. Taking advantage of local candidate forums like this offers residents the chance to be active participants in the American democratic system. Making a decision about who to vote for should be based on knowledge of each candidate’s world view and priority agenda and where those fit with one’s own ideas. The challenges posed by shrinking federal and state budgets means that local policy-makers are having to re-think how to provide important public services in ways that make the most impact. Deciding which programs and services will be cut and which will be kept depends in large part on where residents stand on the issues and the long-term effects of making budget decisions.

If local garbage collection was cut, what would the health and environmental implications be when homeowners and tenants are forced to deal with the overflow at greater cost to themselves or by the illegal dumping that would result? What would the unintended consequences of cutting public health be when free or low-cost infant immunization programs are eliminated or reduced? What would the impact of increased property taxes be on an aging Social Security-dependent tax base? It is vital to have representatives who can work through all of this while assuring that communities can provide for themselves and their futures.

It is up to us to demand that our representatives are up to this challenging job.

Attend a candidate’s forum, take a friend to vote, or write a letter to the editor - just get involved. Complaining about what’s wrong is easy. It’s doing something about it that takes a bit of effort.

For more information about local races and information on polling sites in your neighborhood, visit the NYS Board of Elections website at Deadlines for registering to vote are coming fast and are included here for your reference.

 - Donna G.