The below understates the political and business interests vested in
maintaining nursing homes and kindred institutions. In Philadelphia spot
ads run on television attempting to scare public opinion into demanding more
nursing home funding. There's no comparable emphasis on community based
support services.
ISM
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
On Behalf Of Stephanie Thomas
Sent: Tuesday, September 21, 1999 7:24 PM
To: micasa-list
Subject: newsletter article
Got a request for a newsletter article on MiCASSA, thought some other folks
might be able to make use of this as well...
MICASSA: A Vision for Attendant Services and Supports for the New Millenium
Ever wonder why it's so hard to get attendant services all over this
country? Why even though most folks would obviously prefer to live in our
own homes, over 2 million of us are locked up in nursing homes and other
institutions? The long term care system in America has a terrible bias
toward institutional services with over 80% of the long term care funds
going for these services, so that only 20% are left to pay for ALL the
community based programs. Every state that gets Medicaid dollars must have
a nursing home program, while community based services are optional!
Introducing MiCASSA!
What is the answer? If all goes well, in a few short weeks a bill called
the Medicaid Community Attendant Services and Supports Act, MiCASSA, will be
introduced in the Senate. MiCASSA gives people real choice in long term
services. MiCASSA would allow individuals eligible for Nursing Facility
Services or Intermediate Care Facility Services for the Mentally Retarded
(ICF-MR) the choice to use these dollars for "Community Attendant Services
and Supports." THE MONEY FOLLOWS THE INDIVIDUAL!
Specifically what does this bill do? MiCASSA...
1) Provides community attendant services and supports which range from
assisting with activities like:
eating, toileting, grooming, dressing, bathing, transferring,
meal planning and preparation, managing finances, shopping, household
chores, phoning, participating in the community,
and health-related functions like taking pills, bowel and bladder care,
ventilator care, tube feeding, etc.
2) Includes hands-on assistance, supervision and/or cueing, as well as help
to learn, keep and enhance skills to accomplish such activities.
3) Requires services be provided in THE MOST INTEGRATED SETTING appropriate
to the needs of the individual.
4) Provides Community Attendant Services and Supports that are:
based on an assessment of functional need;
provided in home or community settings like -- school, work, recreation or
religious facility;
selected, managed and controlled by the consumer of the services;
supplemented with backup and emergency attendant services;
furnished according to a service plan agreed to by the consumer;
and include voluntary training on selecting, managing and dismissing
attendants.
5) Allows consumers to choose among various service delivery models
including vouchers, direct cash payments, fiscal agents and agency
providers, all of which are required to be consumer controlled.
6) For consumers who are not able to direct their own care independently,
MiCASSA allows for "individual's representative" to be authorized by the
consumer to assist. A representative might be a friend, family member,
guardian, or advocate.
7) Allows health-related functions or tasks to be assigned to, delegated to,
or performed by unlicensed personal attendants, according to state laws.
8) Covers individuals' transition costs from a nursing facility or ICF-MR
to a home setting, for example: rent and utility deposits, bedding, basic
kitchen supplies and other necessities required for the transition.
9) Serves individuals with incomes above the current institutional income
limitation -- if a state chooses to waive this limitation to enhance the
potential for employment.
10) Provides for quality assurance programs which promote consumer control
and satisfaction.
11) Allows states to limit the aggregate amount spent on long term care in
a year to that amount the state would have spent on institutional services
for such eligible individuals in the year.
12) Provides a maintenance of effort requirement so that states can not
diminish more enriched programs already being provided.
MiCASSA also provides grants for Real Choice Systems Change Initiatives to
help the states transition from current institutionally dominated service
systems to ones more focused on community services and supports. Each state
will create a Consumer Task Force (with a majority of the members being
people with disabilities or their representatives) to develop a plan for
transitioning services into a more community oriented system. The Secretary
of Health and Human Services, along with the National Council on Disability,
will review regulations and report to Congress on how to reduce excessive
use of medical services. The Secretary will also establish a task force to
examine financing of long term care services.
Benefits to various consumer groups:
Studies show that people currently living in America's institutions and
nursing homes -- from children up to seniors -- do not have more severe
disabilities than those who live at home and use attendant services and
supports.
Young people with disabilities are not in institutions or nursing homes
because of the amount of care they need. They are in because of the lack of
attendant services and supports. Families DON'T want to place their
children in institutions; they want children with disabilities to live at
home where they can maintain family ties, go to school and grow as other
children do. Parents also want their children to have a secure future and
real options for home and community services and supports when their
families are no longer providing full-time care.
Some of the real reasons why children and young adults with disabilities go
into institutions or nursing homes are that many parents can't hold down a
job that supports their family AND provide full-time care to a child with
disability. Also, as the child grows up, many parents may be able to
provide much of the care that a young child needs, but may not be physically
able to manage lifting and positioning. In addition, parents fear that when
their child is old enough to move out of the house, no independent living,
community options will be available.
Similarly, Older Americans generally prefer to be in their own homes. They
do NOT want to live in nursing homes. Most people who need long term
services and supports prefer to remain in their homes and to "age in place."
In fact Home-based services DO work for older Americans. Although people
in nursing homes do tend to be elderly (average age: 84 years) many older
Americans are living in their own homes and communities with the help of
community services and supports, but these programs are very limited. Some
Americans diagnosed with Alzheimer's are cared for at home, but both the
individual and the family members need appropriate supports, which MiCASSA
could provide.
Legislative milestones
During the last legislative session House Speaker Newt Gingrich introduced
an earlier version of this bill and the Commerce Committee held day long
hearings on the bill. One thing this hearing revealed was the alarming
degree to which our Congress people still cling to the tired old stereotypes
about people with disabilities and our needs and abilities!
However, during the last session time ran out, so the bill was not passed
and that is the reason it needs to be reintroduced now. This delay gave the
opportunity to include suggested improvements in this new version and for
Senate sponsors to be found.
What does passing such a bill involve?
Just getting a bill introduced does not mean it will pass. MiCASSA has
almost 400 organizations signed up as supporting the bill, but if your group
has not signed on yet, now is the time. Powerful lobby groups like the
nursing home group the American Health Care Association, and pro-institution
groups like Voice of the Retarded are actively working to kill MiCASSA and
end any chance of people having real choice in where and how they get
services. It will take all our combined efforts to create the changes that
are so badly needed.
The bill will have to pass both the Senate and the House of Congress before
it becomes a law. Both Senators and Congressional Representatives need to
hear from you - their constituents - if you think this is an important bill,
why you think so. Personal experiences are a great way to explain that.
ADAPT can provide you with more background information if you need it.
Check out our web site http://www.adapt.org or write us at: 1339 Lamar SQ
DR #101 Austin, TX 78704.
NATIONAL ADAPT MAILING LIST - Adapt MiCASA List of Adapt Organizers.
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