Alternatives to the Nursing Home (4 Letters in NYT Opinion Column)

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The following letters are response to the recent article in New York Times:

New Options (and Risks) in Home Care for Elderly (March 1, 2007) “New Options (and Risks) in Home Care for Elderly” (front page, March 1) depicts the lengths families will go to keep a loved one out of a nursing home.

To the Editor:

Unfortunately, many families remain unaware that assisted living, even in the most expensive communities, can be as little as one-half the cost of even “gray market help” provided at home.

According to the most recent survey, the average annual cost of an assisted living community in the New York area was $40,452. This amount would pay for perhaps five hours a day of a private agency aide, or nine hours of a gray-market worker.

In assisted living an elderly person typically has access to 24-hour assistance, with the cost additionally including housing, utilities, food, housekeeping, laundry, security and activities.

As the aged population grows, we may need to rethink our approach to, and the risks of, homebound care.

Andrew Carle
Fairfax, Va., March 1, 2007
The writer is director of the Program in Assisted Living/Senior Housing Administration at George Mason University.

To the Editor:

The experiences described in your article highlight several key issues regarding long-term care in the United States.

First, unlike other countries, the United States has developed neither a coherent policy nor a true system of long-term care for older adults. As a geriatrician, I have found that my patients are amazed that Medicare won’t pay to help a caregiver provide basic needs like bathing to a disabled or homebound person.

Second, while finding ways to appropriately reward the heroic work of home aides and nursing home aides who do backbreaking, hands-on work, we should recognize that most assistance is uncompensated and provided by family caregivers, usually daughters and spouses.

Finally, in the absence of action, all these problems will only worsen as our population continues to age.

Bruce Leff, M.D.
Baltimore, March 1, 2007

To the Editor:

Being able to remain in one’s community is a choice that should be available not only to people who are elderly but also to people with disabilities. The difficulty in coordinating necessary services, the potential inadequacies in these programs and the lack of funding are three main factors that discourage people.

There is, however, a bill before Congress, the Medicaid Community Assistance Services and Supports Act, known as the MiCassa bill, that would make it easier for people to move from a nursing home back to the community by providing federal assistance for a home health aide of their choice.

This would allow all people to live their lives to the fullest in their community, promote inclusiveness and end segregation of people who are currently warehoused in nursing homes.

Carl Herr
Flushing, Queens, March 2, 2007

To the Editor:

Reading about all the problems connected with care for the elderly, I realize more than ever how fortunate I am as a 94-year-old man to have been taken care of by my two daughters. When my wife passed away, my doctor decided that it was not safe for me to be alone.

Instead of checking me into an assisted living facility, my daughters decided that they wanted me to stay with each one in turn, winter in California and summer in Connecticut.

It is now more than one year and my daughters have expressed gratitude for the opportunity to take care of me. This is a practice widespread in cultures that do not believe in nursing homes for their elders.

Al Goldbaum
San Francisco, March 2, 2007

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