Long Term Care ≠ Nursing Homes

The way America pays for nursing homes is a disaster. So how do other countries do it?

Sarah Kliff, Vox.com - December 14, 2014

Sarah Kliff, who is in my opinion one of the very best journalists on the health care beat, has a very interesting article at Vox.com about how countries pay for “long term care”. Those of us with disabilities and related to disabled people certainly know what a mess it is, but sometimes we don’t know why, and non-disabled people mostly don’t have a clue. Worse, it seems like even the social democracies of the developed world, who usually do human services better, don’t have long term care figured out either.

I hope we get a followup article to this one, because unfortunately, the article equates “long term care” with “nursing homes”. The title says it’s about paying for nursing homes, but the article is about long term care. They aren’t the same thing. Nursing homes is one model of long term care. Others include agency-based and consumer-directed home care, “assisted living”, “retirement communities,” and probably other models, too. It is very dangerous to keep equating the problem of long term care with it’s most outdated, expensive, and, frankly, most hated solution … institutionalization in nursing homes.

In fact, the woman who’s story Kliff cites, a woman with paralysis “from the waist down” is far more likely to need home care than a full-time nursing home. Plenty of people paralyzed “from the neck down” live in their own homes, too, with visiting care and personal assistance. In most cases, this more targeted type of care is at the same time less expensive and less restrictive. The CLASS Act, which Kliff also cites, would have helped with home care as well, and the Community First Choice program is helping in several states as we speak.

Again, this is all stuff that means a whole hell of a lot to people with significant disabilities, and virtually nothing to everyone else … even though it should be common knowledge to everyone. I hope to see more of this kind of work from Vox, and a bit more care in defining the scope of definitions and discussions.