Consumer
Directed Care began in the US in 1998. Since the
beginning of the program, it has been most
effective in improving the quality of life for elders
and their caregivers. It’s a program that makes sense,
not only because it allows the elder and/or caregiver to
direct his or her care by selecting the services and
providers they like, but also because it saves money.
The program has been in such demand that it makes me
wonder why it has not been extended to middle class
families and why there are still areas in the country
where it is totally unknown to the public.
In times
when the financial resources are very limited, we need
to explore ways to serve as many elders as possible, and
do it in a way that will not compromise their
well-being. What better way to accomplish both goals
than by allowing seniors to choose the services and the
programs they want. While Consumer Directed Care is an
ideal programto help families manage their care, the
program was designed to contain costs, not necessarily
to help Medicaid recipients. In government language, the
program is a budget-neutral program. The hope was that
the program will eventually become a cost-avoidance
program for the Medicaid budget. This means that the
success of the program was going to be based solely on
the amount of dollars it saves the Medicaid budget.
With
more individuals becoming frail and living longer with
conditions that require around the clock care, more
resources are needed to keep them at home, therefore,
the original cost-savings anticipated by the program
designers is not being realized, and this is making
government officials think twice about continuing the
program. It is very possible that even though thousands
of elders and individuals with disabilities have
improved their quality-of-life because of this
program,Consumer Directed Care may be cancelled due to
the fact that the financial bottom line, not the human
bottom line has not been reached and the expected
savings are no longer there.
Before
the ax falls on another good program we should become
involved in the fight to save the Consumer Directed Care
and all the other Medicaid waiver programs in existence
today. We need to convey to our elected officials that
Consumer Directed Care should be part of a legislative
mandate in each of our states. We need a legislative
mandate that allocates state funds under the framework
of the consumers’ wishes and direction. Once that is
accomplished, we should also make sure that the Federal
Medicaid program makes Consumer Directed Care a
permanent Medicaid waiver program and not just a
research project. Research projects have their own set
of rules that are not necessarily the best rules for the
caregivers or the frail person. The success or failure
of programs for frail persons should not be based on how
much money the government saved but in how much the
program has increased the quality-of-life of
participants. If money is saved, then it should be an
added value to the equation, but not the only value.
Consider
the following: some families are not earning enough
money to survive, some families cannot afford health
care, some families have given up their jobs to take
care of their loved ones at home and some families are
not paying into Social Security. Under the present
system, these families are in danger. Consumer
Directed Care offers the option to pay family members a
salary similar to the salary they pay now to private
agencies for the work they do. If family members are
able and willing to perform certain services, they
receive payment and a contribution to their Social
Security. Paying family members at the lowest range of
the payment scale saves money because family members
provide more hours of services than an agency does for
the same amount of money.
Some
families are not able or willing to provide services
themselves, but they would like to choose the agency or
individual worker who will provide services to their
loved ones. If an agency is not providing the
services the way a frail person desires, caregivers
should have the right to change providers, no questions
asked. Having the power to change agencies
should be the right of the consumer in any government
funded program.
In a
time when the federal government is considering
eliminating the Medicaid program as it exists today, and
making Medicaid a Block grant to the states, the warning
has been given. It is up to us to fight for the
preservation of those programs and services that make a
real difference in people’s lives.
Gema Hernandez is the former Secretary
of the Florida Deparment of Elder Affairs. During her
tenure, she facilitated the most comprehensive programs
for caregivers in the nation. Dr. Hernandez is now a
consultant. She can be reached at: elderreadycommunity@earthlink.net.
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