Why Institutions?

They have been a couple of interesting happenings since I lasted posted here. The most important, I believe, is the recent news that Albany's ubiquitous care provider, The Eddy, is developing new types of housing. The Eddy has always been ready to innovate, to try new things, so it's not surprising to see The Eddy working on new plans for residences. But there is still something that, in the words of Peter Griffen (of "Family Guy"), really "grinds my gears." It's this nagging feeling that people's life trajectories are on the wrong track. No matter how nice the residence may be, why do so many people wind-up in institutions?

A colleague of mine, Constance Laymon of Consumer Directed Choices, has been known to point out that persons wind up in institution even though they have been convicted on no crime. Why do people find themselves in these total institutions? Isn't there something wrong about that? Yes, I want all nursing homes swept away with a sweep of my arm. No, i don't believe that an person should be in those environments.

So what's my alternative? I don't really have a good one, but revamping the concept of the nursing home is essential to human dignity. First of all, though, the structure of the total institution has to be eliminated. (Just to clarify, institutions are a special category of group quarters: prisons and nursing homes are good examples, secure facilities where the resident does not have authority or ability to freely travel.) It's hard to maintain one's sense of self, of individuality, let alone self-respect, when living in an institution. That's no way for people to live in the twilight of their lives, and it's no way for the younger to have to spend their entire lives. This is essential: the sense of self, of intellectual integrity and independence, must be maintained, and any environment that structurally stifles those things is unacceptable.

Bravo to The Eddy for trying new tacks in long-term care, but there's still a long way to go.

Things are getting smaller.

Things are getting smaller: did I say that already? Well, it bears repeating. After four weeks of not moving around a whole lot, I'm starting to move around again, and with that, the world starts to shrink. On Monday morning the 21st, the morning after my accident, the world was about the size of my bedroom. It took a couple of weeks before I could move about with some ease, but as I started to move about easier, as the leg pounded less as I tried to swing it over the side of the bed, suddenly the distance down the hall seemed to shrink to a manageable way to travel. The whole world seems like that.

If you happen to be unable to get around, the world seems like a really big place. I still don't walk all that far without tiring, so the distance from the parking garage at work to my office is about all the walking I can do; in fact, the walk back seemed downright un-doable the the other day. If I have to, I can walk down to the end of my block to get the bus, which saves me the need to step on the clutch of my Subaru; what happens if there isn't a bus stop at the end of the block? What if I had to walk two blocks, or ten? And then if that walk can not happen, the world is an infinitely bit place -- make that, Albany is an infinitely big place. You can't get there from here.

In the City, bus options are pretty good, at least where I am. To my south, in Delmar, it's going to be a bit further to the bus stop. What happens to folks who "age in"? What happens when people don't have the ability to walk as far, or to drive, and their options to travel are taken out of their own hands? My mother, on Long Island, would say that the worst thing that ever happened to her was not being able to drive (I pointed out that living in a country that had gone to war four times, World War II, the Korean War, the Vietnam War, and the Iraq war -- Kuwait hardly counted -- was a significant social upheaval, but she missed that point: I don't think she would be alone). It is scary how we don't have a way to, how shall we put it, degrade gracefully (that's a communications term I picked-up years ago about how communications systems should be designed as they go through the EMP, electro-eagnetic pulse, associate with a nuclear detonation).

The point should be taken, that people are going to become increasingly limited in their transportation options as they age, and if they wish to age in place, to stay in their homes, to be able to get around, they are going to need some transportation infrastructure when their own means fail. Of course, they could be like me and get a disability of sorts earlier on. But then, my disability is of the passing nature.

So for me, right now, things are getting smaller. That may well be only a temporary experience.

Elder Abuse?

Is elder abuse an issue here in the Capital Area? The Eddy, the regions ubiquitous provider of human services, was the subject of an article in yesterday's Times Union. According to the TU, "The Eddy will offer a 24-hour hot line, counseling, emergency housing with nursing care if necessary and, in partnership with Albany Law School, legal advice." If this is a needed service, then this is a sick society: according to the article, "According to the National Center on Elder Abuse, there are between 820,000 and 1.8 million seniors abused each year in the U.S."

But we've really known for a long time about elder abuse. Years ago - - I haven't followed this lately, maybe still - - it was headlined in the newspapers as "granny bashing": grandmothers getting beaten for the social security checks and the like. And it's an international issue, as noted previously. So why, on top of everything else that the elderly have to deal with, are they also the subjects of abuse?

Nothing is really new, is it? The elderly are the weak. The weak are the victims. But isn't it more than just wanting to steal somebody's social security check (or life's savings)? People in nursing homes have been abused by staff: what a paradox, the caregiver, the professional caregiver, becoming the abuser. There are some philosophies (Marxism may be one) that argue that social inequality is the root of all evil; that's certainly a nicer scenario than one that people are just evil. But let's not toss Marxism away too easily. By denying people the ability to meet their basic needs, to force people to live on the margins of society, what do we expect to have happen? By creating poverty, by maintaining poverty, we ourselves lose the moral high ground: so who really is evil?

Safety Nets?

The headline in this Sunday's Times Union, one of the headlines, the one on the far right, so I guess the most important headline, above the fold, told us that "Slowing growth now hits insured." And they added that "Even those protected by employer plans find rising share of costs, limited coverage mean a medical emergency can plunge them into debt[.]"

Let's take a minute to get our minds around this. If you don't have medical insurance and you get sick, you have to spend down to the Medicaid threshold to be eligible for state-sponsored insurance. You basically have to impoverish yourself. You don't get thrown out of your house, but you may find a lien on it. You get to keep $725 a month, if I recall correctly, and that's a grand total of $8,700 dollars a year to live on. I think I have that right; I think that's really poverty.

But let's also get to this other point, the one about the insured who also wind-up in debt. So let's say you have a job, making more that $8,700 a year, and you don't have the correct coverage for exactly what ails you. So there's a deductible, or a co-pay, or a limit on coverage. So people go into debt: they don't send their children to private school, they don't make improvements on their houses, they don't have their hair done, they don't go out to dinner, they don't have the oil changed in their car. For how many years? How many illnesses?

Why do people have to go into debt if they get sick? Whether or not they have insurance, whether or not they have "enough" insurance, why do people have to get poor to get better? Am I missing something here? Why does good health get tied to good wealth? This is a scary idea, that if one has money then one has access to health care, and an absence of money means an absence of access to health care. (Remember that line from The X-Files, the "cigarette smoking man" to his son, "Access, agent Spender: it's about access.")

What about access? Let's read the New York State Constitution,Article XVII,Section 1:

• The aid, care and support of the needy are public concerns and shall be provided by the state and by such of its subdivisions, and in such manner and by such means, as the legislature may from time to time determine.

Are we missing some there? If people have to go into debt to pay for their medical care, with or without medical insurance, that sounds like the definition of "needy" to me. Where is the help for these people? Why should anybody have to go into debt, in many cases ruinously so, just to live a healthy life, if not just to live, period. Don't we have a responsibility to provide "aid, care and support" to all? Isn't it time for a universal and all encompassing health care plan for all?