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Stimulus offers chance for long-term care reform

The federal stimulus package, specifically the $12.6 billon boost for Medicaid funding to New York over 27 months, gives the state the opportunity to do the right thing by its frail elderly and disabled citizens. Instead of the proposed $1.4 billion in cuts to vital health services for seniors contained in the administration's original budget (nursing home care, home care and other long-term care services), the federal aid affords a two-year window to craft genuine policy to meet our moral obligation to these vulnerable New Yorkers, and to significantly improve the system in a cost-effective manner.

For more than 20 years, state policy makers have repeated the same mistake: They create a budget, then try to cram long-term care policy into it. In the absence of a thoughtful, moral vision of care, senior care has experienced annual reductions totaling billions of dollars. The result is a system overly dependent on nursing homes, one that ignores the role of housing, underutilizes adult care facilities and assisted living and costs more than it should, all for want of a policy framework.

The current budget proposals are doubly shortsighted. They will lead to massive layoffs of nurses, home care aides and other caregivers (1,800 in Western New York, up to 20,000 statewide) at a time when we need more jobs (we're talking, after all, about a stimulus package), and the loss of those caregivers will seriously erode the care of those most in need. The cuts make no economic sense, and they are morally unjustifiable.

The stimulus package offers us the chance to get it right. First, it obviates the need for all proposed and recently enacted cuts, thereby saving jobs and sustaining levels of care. Equally important, it gives us time to craft a vision to meet our needs for the decade ahead and develop the policies (and budgets) to meet our obligations.

In 2006, the Legislature voted by a combined 211-1 to reform the Medicaid payment system for nursing home services, and it rejected major home care cuts. The 2007 budget saw a retreat from those promises, but the Legislature recommitted itself in 2008. By doing so, legislators reaffirmed their obligation to a system of care that is patient-centered, rather than budget-driven.

We all agree that the status quo is not sustainable. The not-for-profit and public members of the New York Association of Homes and Services for the Aging exist to carry out long-standing missions of service to the elderly and disabled. Using the stimulus package to stabilize their finances will enable these organizations to downsize their nursing homes where appropriate and diversify their services, be it in home care, housing, assisted living or whatever their communities need.

This will assist the state to carry out its moral imperative to care for the neediest, and to do so in a financially responsible, sustainable manner.

Carl Young is president of the New York Association of Homes and Services for the Aging.

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