|Quiet but profound changes in the field of aging (Kellogg 6/3/12)||| Print ||
In April a quiet but profound change happened at the federal level. At least it was big to those of us who watch trends and have professions in the field of aging.
A statement from Cabinet Secretary of Health & Human Services Sebelius announced the bringing together of the federal Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities into a single new ”Administration for Community Living” [ACL]. The new Administration for Community Living is headed up by Assistant Secretary on Aging Kathy Greenlee.
I felt like my professional life came full circle.
In 1976 I was staff for the Michigan based portion of a White House Conference on Handicapper Affairs. “Handicapper” was the action oriented term of the day for predominantly younger persons with disabilities spreading awareness and forming recommendations for changes in federal policy and law that would make it easier for people with disabilities to live independently.
By the end of 1976 I was working in the field of aging where different but parallel trends were gaining steam. In 1965 Medicaid was created to provide mostly acute care for the poor, as well as nursing home care if needed. This had the unintended consequence of driving out county poor farms and other “mom and pop” operations in favor of more medically sophisticated care of infirm elders.
The result was tremendous growth of Medicaid expenditures on nursing home care. It soon became a top discussion point in state budget debates. Beginning in the mid-1970s and on through the 1980s the search and rallying cry for additional, less costly options than nursing homes became constant.
Also in the mid-1970s, a newly formed national network of locally-based, often private entities designated as Area Agencies on Aging began putting into place non-medical community services to help people stay independent in their homes. The work of this “aging network” heightened the push for Medicaid to offer home-based options rather than just nursing home care.
In 1982 the first of what became known as optional “Home and Community-Based Service” [HCBS] waivers was put in place to “waive” Medicaid rules to allow persons eligible for nursing home care to receive services in their home rather than having to move into a nursing home. Generally less costly than nursing home care and in demand by the populous, HCBS waivers quickly spread to all states.
Meanwhile, advocates for persons with disabilities were making great strides in advancing their cause. In 1991 the federal Americans with Disabilities Act [ADA] passed. It recognized that people with disabilities had a right to specific accommodations in housing, employment and public services. By the mid-1990s many states, including Michigan, planned their HCBS waiver to include all qualifying adults aged eighteen and up rather than just seniors.
As the population aged it was expected that the ratio of Medicaid funds would shift from a past of funding only nursing home care to a balanced ratio between nursing home care and care in one’s own home. The intent was to spread the per person cost over much greater numbers, making the program more affordable.
The intended shift however, has been slow. In 1999 in Georgia, a couple people were offered only nursing home services and denied access to service in their home(s). They sued the state for the right to receive service in their homes, had their case heard by the U.S. Supreme Court and won. The resulting “Olmstead” decision required all states to move more aggressively in offering home based options.
Now here we are in 2012. Progress is still slow, but moving, spurred on by a steady coming together of the work of aging and disability advocates. Older persons have taken on more of the view of younger persons with disabilities seeing varied accommodations such as hearing aids, canes, walkers, scooters and barrier free design elements like curb cuts and better lighting as helpful “tools” to continued independence. Disability advocates, historically distancing themselves from the field of aging, increasingly acknowledge commonalities of mutual benefit.
The new Administration for Community Living provides a great springboard for increased collaboration. There’s already a lot going on in southwest Michigan. Free feel to call the Info-Line for Aging & Disability at 1-800-654-2810 to learn more.
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