The time has come to address an injustice that is being perpetrated on seniors with chronic conditions and people with disabilities. This injustice originates in our Medicaid law and results in over 2 million people residing in nursing homes and other institutions.

The Medicaid system was created in 1965 to address the long term care needs of families becoming reliant on multiple wage earners or living far from parents. This system of institutional care that was created has always been mired in serious issues of abuse and neglect of the residents. The nursing home industry has prospered with the federal entitlement to institutional care leading to 45 billion Medicaid dollars a year being spent on institutional care. The result has been the placement of people in places where they, the residents lose most of their rights and their self respect. They lack personal privacy and forfeit access to space that they can control and these forsaken people often face inadequate care, loneliness, depression, over medication, malnutrition, and physical, emotional and verbal abuse.

A recent report prepared by the Minority staff Special Investigations Division of the Committee on Government Reform of the U.S. House of Representatives stated, "The 1987 nursing home law was intended to stop abuses in nursing homes by establishing stringent federal standards of care. Although the law and its implementing regulations require appropriate standards of care, compliance by Chicago nursing homes has been poor." This report identified the following types of problems:

1. Failure to prevent or properly treat pressure sores
2. Inadequate nutrition
3. Failure to properly clean and care for residents
4. Failure to provide proper medical care
5. Improper use of physical and chemical restraints
6. Failure to prevent falls and accidents
7. Inadequate staffing

This report which was requested by Representatives Blagojevich, Rush and Schakowsky shows the inability of nursing homes and institutions to meet the long term care needs of seniors and people with disabilities in a manner that honors their self worth and autonomy. Over 11,000 nursing homes or 65% of the total are operated by for-profit companies in this 94 billion dollar a year industry. A study just released by CURL (Center for Urban Research and Learning) at Loyola University did a survey of residents of Chicago nursing homes and found that 65% would rather be living some where else.

Given this dismal situation it is imperative that Congress act to support the demand of the people to change our system of long term care. We need a change. Seniors and people with disabilities will no longer accept being warehoused when they become restricted in their ability to do self care. Options have existed for decades but their spread has been fiscally choked off by the fact that 80% of our long term care dollars go to institutional settings in spite of the fact that studies show people do better in home and community settings.

My recently introduced bill, H.R. 4416, The Medicaid Community Attendant Services and Supports Act (MiCASSA) creates a new day for consumers. It allows consumers to choose if they are to get the needed assistive services in a home and community based setting or in a nursing home or institutional setting. It lets the funding follow the individual and to serve their care needs where they live and does not force people to turn to unwanted nursing home placements to get personal care.

This bill has incorporated the best features of home and community programs originating in the states and implements them nationally. It uses dollars formerly going only to nursing homes and frees them for the community based services desired by seniors and people with disabilities which not only provide better quality services, but also better health outcomes and greater consumer satisfaction. Not only is it better but community service also saves money for all tax payers. That cost issue becomes important as we see our population aging and the likelihood of greatly increased demand on long term care services.

Some of the features that MiCASSA has included are: It allows all individuals who are eligible for nursing home or ICF-MR services under Medicaid to choose to receive community attendant services and supports instead with ongoing funding and quality assurance provisions. This program is open to all consumers regardless of age or disability type (physical, cognitive or psychiatric) if they meet the level of need determined by an evaluation of functional abilities. It would provide services at levels that would support people needing 24 hour care in the community. The program will include money to help individuals transition from institutions to a community setting. This would include first months rent and utilities, furniture and house wares to set up a home. It allows states the option of a buy-in for people earning too much to qualify for Medicaid directly but needing attendant services to function.

MiCASSA allows people the freedom to choose. It does not force people into institutional confinement as current Medicaid law does. It completes the work of the Americans with Disabilities Act which says that people with disabilities have the right to be active participants integrated into the everyday life of society. It refutes the paternalistic patterns of the past that took away your rights when you became disabled. We must act now to spread freedom and raise up all of our people stuck in nursing homes but wanting to live in real homes.

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He's gonna dis me for this, but, Tom at Access Living wrote this speach with some great resources he referred to. He told me today that there's probably a couple of more things to add to this speach before he submits it to Danny Davis. Great work Tom!