Whose job is insurance?

The news today, besides the weak economy, is that John McCain is proposing a health care plan for people who would have problems getting health care: people like him, for example (cancer history). It's still a private industry plan, say some of the critics. That's an interesting point; or, it's interesting that they are making that point. Is it wrong to propose a private-industry-based health-care plan?

Are there some things that are too important to be left to the private sector, some things that are so important they need to be done only by the government? We take for granted that some things are the exclusive purview of the government, although lines sometimes get blurred: foreign policy (but then there's Jimmy Carter off to the middle east); military affairs (not counting Blackwater, or, for that matter, the entire military-industrial complex, just as Dwight Eisenhower warned); and there's also the mundane, the highway departments, local library districts, and we all went to town-hall to get marriage licenses (or those of us who could, did). So we can all pretty much agree that there are some things that governments do (beyond the Hobbsian essentials of smoothing the wheels of social and economic transaction). So, if we all believe that governments should be in charge of paving the roads (even if a contractor actually lays the asphalt), why should providing for health care be any different? For anybody, for that matter: not just the problematic cases. Aren't there some things that are just too important, too essential to be left to the vagaries of private industry and the free market?

How does a 78-year-old woman starve to death in her own home?

This one calls out for something, something real, something dramatic, something substantial, something to make a difference. Yes, there is elder abuse in the world; friends of mine have devoted themselves to the cause; it is an international cause, in fact (see the International Network for the Prevention of Elder Abuse); but what is so shocking is how this happened. About a mile from my own home here in Albany, this woman starves to death in her own bed in a home she shares with her daughter.

Let's not try anybody right now: let's just look try to find the social realities that surround this case. What has been reported is that a 47-year-old woman shared a home with her mother, and, according to the Albany Times-Union of Saturday, April 26th, "At some point, and for reasons that remained unclear Friday, she stopped feeding her mother enough to keep her alive." So, here are a couple of ideas on that:

• Nobody noticed the older woman hadn't been seen around for a while? Maybe not a call to the Elder Abuse Hot Line (New York State Adult Abuse Hotline: 1-800-342-3009, press option 6 [options six?]) but couldn't somebody have been gotten into the loop? Maybe -- maybe -- all it would have taken would have been a phone call -- to the local Office for the Aging or Department of Social Services -- to have a case manager become involved.

• How does an older adult -- apparently confined to home or even to bed -- not get into the community-based long term care system? How does a person reach the point where they cannot feed themselves and not have an aide? Don't people know to call for help? Isn't that what the blue pages in the telephone book are for? [They still have the blue pages, don't they?]

• Why do we in the aging services network not know about our (potential) clients unless they throw themselves at our faces. Shouldn't we have a way of knowing these things?
  

Shouldn't the care system be a true cradle-to-grave network where a person is never far from (life-sustaining) help when needed? This is a tough nut to crack: how do we track somebody through their lives so that we are there when they need us? Is there to be some eye-in-the-sky that all-knowingly sees people, tracks their records, determines when they need aid? It's important to every person that the needy not fall through the cracks, so important that this question needs to be asked.

We've done a pretty good job at getting all people into some parts of the social services system, either through a type of default, this is how it's done mechanism or through global awareness. The Social Security system nets people seemingly from birth; all people age 65 and over seem to know to get into Medicare. Why can't we get people into the aging network of services before they starve to death?

There are so many people who are slipping through the cracks, in one form or other, that we need to reexamine what it is we are doing with our service system and why we miss people who are truly in need. We should know where the elderly are, we should know whom among them need support, and we should be able to offer that support. Forget arguments of costs of community based long term care versus nursing homes or other residential facilities. This is a question of basic morality: people should not be abandoned to starve in their own beds, and if they do they've been abandoned by all of us.

Two things today

Personal Update:

I'm a bit more comfortable now, but my leg is still not quite up to trips off the second floor. Oh, but the way, day-time TV is a vast wasteland.

From today's Paper:

A brief note on an article out of Schenectady, there will be a diet and diabetes program for children and adults living with diabetes, "The Diabetes and Nutrition Awareness Program." This is a good idea, and in fact ought to be expanded into a universal nutrition awareness and diabetes screening program. In an era when diet and the increasingly early onset of type II diabetes have been linked (risk factors generally are increasing age, obesity, and physical inactivity), promoting good dietary habits is clearly a positive public health undertaking.

Consider for a moment that preventing diabetes (i.e., preventing early -- or any -- onset of type II diabetes) would have tremendous benefits not only for the day to day quality of life of the individual but also for the costs of treating long-term a person with diabetes, costs that ripple through the health-care system. Any expenditure on prevention would certainly ultimately pay rewards many fold.

Which raises a question: why don't we spend more money on prevention? Shouldn't we be blanketing schools and senior centers with nutritional awareness education? Shouldn't we be plastering bill-boards and the pages of newspapers with pubic awareness ads extolling the virtues of healthy eating and exercise (and, to go along with that, making sure there is an awareness of the problematic nature of the fast-food diet)? Why is this a bad idea?

Are we afraid of offending the fast-food industry? Certainly by now we are aware enough of the link between diet and health issues, and we are aware of the link between a fast-food diet and health issues, so why be afraid of offending anyone? Or does it just seem unseemly for the state government (or the feds, for that matter) to go to war with an entire industry of food providers? Can that really be all there is to it?

Irony

I'm writing this, my first CACAD blog entry, at an odd juncture in my life. To give the punch-line away first, I've just transitioned from an aging issue to a disability issue. My mother, for whom I've been a long-distance caregiver for the past several years, died on April 15th; on April 20th, I was involved in a motorcycle accident.

I write this, I'm lying in bed, in my second-floor bedroom, without a real prospect of going downstairs. No, the house is not built well for movement on crutches. It has three living levels with stairs up to the main floor, more stairs to the second floor (where I am now), and a downstairs with -- you guessed it -- stairs. So my first exposure to disability is that my house is not very disability-friendly. In fact, the irony is that I'm trapped in my own second-floor bedroom: me, someone who should know better.

O.K., there were options. I might not have struggled up the stairs Sunday night, but it is my bedroom, where I'm comfortable (the lumps in the bed are all in the right place), so it's where I wanted to be. And I'd already gone up one flight of stairs just to get to the first floor, so I just kept going. And then there was the big option: seven years ago, when I bought this house, I could have opted for a ranch instead, using proper foresight.

Is it really even an issue, that houses have two or three floors of living space and -- as we age-in -- we can only manage one (without substantial expenditures or efforts)? A friend of mine once told me he and his wife were moving to "an old-man's home," a single-level ranch, long before he was unable to negotiate stairs (he still has no problems, but he's there now just in case).

So here I am, supposed to have an idea about housing issues and all that, and I'm trapped anyway. Does one have some type of social or personal responsibility to plan for a life trajectory that will, with a fair level of inevitability, find one as an older adult with limited mobility? Do we all have to plan, to say there is some essential -- and specifically required need to plan for the inevitable decline. Am I socially irresponsible -- or worse: morally bankrupt -- for not having already gone to the old-man's home in preparation for the disabilities of older age. And let's not forget that a disability can affect a person of any age: are we foisting fundamentally inappropriate homes on people, people who at any moment be living in suddenly inaccessible residences?

Are multi-level home (e.g., split-levels, high-ranches, Victorians, etc.) the social equivalent of drinking-and-driving, especially for people over a certain age? (The young -- especially with families -- may be indulged, but of course there's always that possibility of the unforeseen disability.) I'm not sure. I suspect that it is not unreasonable that people should have expectations in line with reality. I know that for every day a person ages it is increasingly likely that he or she will become impaired. Some people, like my mother, will be forced from their homes, in her case at the age of 81, just a year before her death; some (like my maternal grandparents) will live at home (in their custom-built split-level) in essentially good health and unimpaired mobility until their deaths. There's me, presumably only temporarily stranded up here (but there was a guardrail about an inch from neck on Sunday).

Travelling around Albany, we see all manner of multi-story dwellings. The old housing stock along Madison Avenue and State Street around Washington Park is typical of much of the city (I think of this as the generic inner-city brownstone-type, walk-up-type house: that may be somewhat inaccurate, but it gets the idea across). The outer areas of the city, the less urban, more suburban neighborhoods, look like the typical suburban neighborhoods anywhere: that is, multi-stories. It is what it is.

Where does that lead us (or, where does that leave us)? Our housing stock is what it is. Older adults and the disabled are perhaps among the least likely (economically least capable) to have new homes built (or existing ones remodeled) to fit their needs. I do not have an answer for these questions, at least not right now, but I do believe that there is a need have housing match the needs and capabilities of the population, and that we all have to think about this.