Waxman, Nursing Home “Reform” and Progressive Jobs

While the AFL-CIO has alarmed environmental and other activists by throwing its support behind big oil and Bush’s backwards energy policy, Henry Waxman has alarmed disability activists by throwing his support behind the nursing home industry and perpetuating the nation’s outmoded long term care policy, namely institutionalization.

There have been a slew of reports lately on nursing home abuse. The most recent one Waxman uses details thousands of incidents and a range of abuses, including instances of nursing home residents being punched, kicked or choked by staff members. Other abuses include untreated bedsores, inadequate medical care, malnutrition, dehydration and inadequate sanitation and hygiene. Some residents also complained of workers groping and sexually assaulting them.

“The senior citizens who live in nursing homes are frail and vulnerable,” Waxman said. “They deserve to be treated with respect and dignity–not to live in fear of abuse and mistreatment.”

Those of us active in long term care policy certainly have first hand experience with the abuse in these euphemistically named” homes.” But many of us would not agree that nursing homes are reformable or that they can ever be a model for good public policy.

What’s more, elderly people are not the only nursing home residents. Younger disabled people who are trapped in institutions by lack of any alternative services seem to be off Waxman’s radar screen.

Suzanne Jand, for instance, wrote “I heard Henry Waxman and was appalled. Beginning in 1970, I lived 23 of the longest months of my life in a *good* nursing home. At age 19, thinking I might be there forever, I took and passed the licensing exam, becoming the nation’s youngest licensed nursing home administrator (heh, we all make mistakes!). Any abuse being reported is at least triple in number as well as severity-and that is a very conservative estimate! I saw death records changed, know about the rapes, wonder if the inspectors still notify the homes when they are going to inspect, so much more.” She adds “And society was less cold in the early 70’s.”

Bob Kafka of ADAPT wrote “somebody in LA/California save us from caring Democrats (Henry Waxman is leader of the pack) who have recognized that people are being abused in nursing homes and guess what he wants to do? – yup – more $$$ for oversight, more $$$ for quality. Never has entered their minds that nursing homes are a corrupting service system that will always lead to abuse no matter how much $$$ you throw at them.”

Janda suggests “Let’s STOP the lie!!” I agree.

In testimony before the Senate Special Committee on Aging several years ago, the national SEIU, representing nearly a million nursing home workers across the nation, voiced concern about substandard care at nursing homes. “Our members witness first-hand the abuses that hinder their ability to give nursing home residents the care they deserve,” said SEIU International President Andrew Stern.

Isn’t Stern aware that the saga of private nursing home “care” in the U.S. was carefully documented as early as 1980 by B.C. Vladeck? The commercialized nursing home industry of more than 17,000 facilities back then had deteriorated to the point where it represented a grave threat to the health and well being of its “patients.” [Unloving Care: the Nursing Home Tragedy] Over twenty years later of ongoing abuses the union’s focus has paralleled Waxman’s proposed reforms. Both push for increased funding to nursing homes, mandatory staffing levels – basically a job creation strategy for union workers. Both can be seen as reactionary rather than progressive. They are typical of liberal-type reforms which ignore central issues. Nursing homes are an industry that reap their blood profits from warehousing people who have little or no alternative to institutionalization. Secondly, neither seniors nor younger disabled persons have said that they *want* to live in nursing homes, rather, that is the model thrown at them by the well endowed nursing home lobby and the Washington politicos in bed with them — and a society which largely accepts this arrangementment because it refuses to or can not deal with family members who need daily assistance with living. The impetous among disabled and elderly who bear the burden of our awful system is towards in home supportive services.

Let radicals understand that the nursing home is a capitalist solution as to what to do with “unproductive bodies,” those who do not provide an able body to create surplus value as laborers. Disablement and constructed dependency is big business. Institutionalization as national policy, evolved in part from the cold realization that financing “Medicaid funds 60%, Medicare 15%, private insurance 25%” guaranteed a source of entrepreneurial revenue. When a single impaired body generates $30,000-$82,000 in annual revenues, Wall Street brokers count that body as an asset which contributes to, a nursing home chain’s net worth. Though transfer to nursing homes and similar institutions is almost always involuntary, and though abuse and violation of rights within such facilities is a national scandal, it is a blunt economic fact that, from the point of view of the capitalist “care” industry, disabled people are worth more to the Gross Domestic Product when occupying institutional “beds” than they are in their own homes.

Such commercial enterprises are staffed by a hierarchy of professionals who depend upon the class of impaired persons to survive. Disability theorist Michael Oliver writes:

[under capitalism] the production of the category of disability is no different from the production of motor cars or hamburgers. Each has an industry, whether it be the car, fast food, or human service industry. Each industry has a workforce which has a vested interest in producing their [sic] product in particular ways and in exerting as much control over the process of production as possible.

Who controls the services, what those services are and where they are rendered are major issues in disabled people’s struggle for self-determination and social membership.

If the average cost to keep someone in a nursing home is $40,000 a year or $90,000 in the case of the Laguna Honda nursing home in San Francisco, then disabled persons could be allowed to use that money for services at home. With such an amount, workers can certainly be paid a decent wage with health care and sick pay and time off. Such a move would benefit workers far more than increasing wages in institutions. There are many reasons why.

The majority of nursing home and home care corporations operate for profit. To maximize profit, they cut corners in quality of care and keep worker pay low to show their owners and investors as high a return as possible on their money. Similarly, home care corporations charge some states as much as $16.50 an hour and pay the worker little more than minimum wage. Corporate managers and owners reap 6-digit salaries and bonuses, while workers, paid below a living wage, are given more tasks than they can physically, emotionally or safely handle. This is a corporate agenda, one that exploits both labor and disabled peoples’ bodies for the benefit of the few at the top.

A rejection by both disability groups and unions of the nursing home corporate paradigm means a rejection of the logic that human labor and disabled people’s bodies must be reduced to commodities for sale. The proposed model of in home services offers a counter paradigm to disablement as a market commodity because there is no profit involved between the worker and the disabled individual. More funding is then freed to go to living wages and benefits and hours of service instead. Progressive unions already know that the profit motive takes dollars away from both quality services and worker take-home pay. Supporters of institutions do so because it’s one way to avert a loss of funding that perpetuates the system which both employs and validates them.

Fears about job losses have often diverted organized labor from a longer-range understanding of issues. Unions’ preservation of jobs in logging, for instance, have rammed up against the goals of preserving our environment. But loggers and their children will also suffer the consequences of a permanently damaged landscape. Labor must understand that it too will benefit by making in home services the dominant long term care model in the nation. Union workers themselves become disabled; many will require long term care as they age.

How many nursing home workers would really like to *live* in the institutions they now work for?

The AFL-CIO’s recent bargain with the oil industry to create more union jobs at the expense of sensible environmental and energy policy certainly is a big step backwards. Isn’t it better to create more jobs cleaning the environment and developing clean energy technologies than by making more jobs in an industry which pollutes the environment and undermines our future?

Similarly support for more tax dollars to create jobs in the nursing home industrial complex is bereft of vision. There is no acknowledgment of disabled persons oppression here — bias towards nursing home funding ends up unnecessarily institutionalizing us. What is radical would be to create more jobs that have the potential to liberate persons rather than warehouse and reduce them to raw materail for the investors and owners of nursing home corporations.

Waxman and those unions supporting nursing home “reform” need to become advocates for in home services, not the nursing home industry. The Medicaid Community-Based Attendant Services and Supports Act of 2001 (S. 1298) introduced in the Senate by Senator Tom Harkin (Kennedy, Clinton, Biden and Specter are the co-sponsors) is a good place to start. It would make in home services an option under Medicaid and Medicare. The bill has a 5 year phase in during which time the states can get an enhanced match — a higher percentage of federal Medicaid dollars — if they provide community attendant services and supports. At the end of 5 years all states must provide community attendant services and supports.

Why not go beyond Waxman’s liberal reform and push to radically change the national paradigm of long-term care to an in home services model that is based on a contract/partnership between workers and disabled and elderly people ourselves?

Marta Russell is the author of Beyond Ramps: Disability at the End of the Social Contract. http://www.disweb.org/

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