From Nursing Home to Own Home

http://www.nytimes.com/2016/05/23/opinion/from-nursing-home-to-own-home.html

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To the Editor:

“Disabled, Confined and Longing to Go Home” (front page, May 14) gives much-needed attention to the plight of people with disabilities unnecessarily confined to institutional settings. States can do better.

In Delaware, we have more to do, but we’ve increased Medicaid-eligible residents who receive home and community-based services by 92 percent over six years. Previously, 64 percent received care in a facility. Now the majority receive care in the community.

However, the article does not focus on one critical point: employment. Many of these individuals not only should live in the community, but also have talents to benefit employers. The personal fulfillment that only a job can provide also gives them the best chance to remain independent.

States can help. It starts with Employment First policies requiring agencies that serve people with disabilities to prioritize employment assistance. Second, we must provide a forum for businesses that employ people with disabilities to show their peers that doing so isn’t about charity, but about finding talented employees.

And, to ensure that employment trends improve long term, Delaware has started to provide young Medicaid recipients (age 14 to 25) with individualized services such as an employment navigator, personal attendant services and assistive technology.

JACK A. MARKELL

Dover, Del.

The writer is governor of Delaware.

To the Editor:

You mention the requirement for nursing homes to ask all residents if they want to speak to someone about leaving the nursing home. Last year we published a report on the effectiveness of that requirement in New York nursing homes. We found that a majority of nursing home staff do not think that it is a good idea to ask the question, and many are not asking the question at all.

Many decide for the resident what the answer will be based on their view of the resident’s disabilities. Some who do ask the question do not refer the resident to the agency designed to counsel him or her.

We urged the state to train nursing home staff members, residents and family members about the need to ask the question and to help those who want to receive care in the community. We urged better monitoring by the state by holding nursing homes accountable for asking the question in a way that encourages residents to think about receiving care in the community.

In our interviews with people with developmental disabilities who had left nursing homes, it was clear that they were happy to be out in the community.

CYNTHIA RUDDER

SUSAN DOOHA

New York

Ms. Rudder is a consultant on long-term care issues and founder and former executive director of the Long Term Care Community Coalition. Ms. Dooha is executive director for the Center for Independence of the Disabled.

To the Editor:

Your focus on the disabled forced to live in nursing homes is commendable, but not the whole story. Even those with sufficient resources that make it unnecessary to rely on Medicaid face unreasonable barriers.

My brother was physically disabled as a result of an accident two years ago and is living in a nursing home. Despite having the resources to afford assisted or independent living, we have not been able to find a single such facility in all of Nassau County that will accept him.

A for-profit facility that could meet my brother’s needs, and that is a mile from where he grew up and close to family and friends, would not accept him based on vague and contrived reasons. What I suspect it is really doing is cherry-picking its residents to maximize profits.

We are faced with a heartbreaking choice: leave him where he is, watching TV all day but reasonably close to family and friends, or move him 40 miles farther away to an independent living facility in Suffolk County that is willing to take him so that he might build a better life for himself.

KATHLEEN PRATT

Vergennes, Vt.