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Posted: August 18, 2004

Professional Caregiving

Olmstead's Implications ? What Are We Doing?

More than four years ago, the Supreme Court ruled that restricting the disabled to institutional choices for their long-term care was both isolating and discriminatory.

As a result, state offices of aging and departments of elder affairs were mandated by the Olmstead Act to create tsk forces to examine the implications of this ruling for their institutionalized citizens seeking home- and community-based options that might be, but probably aren't, available in their communities.

This disability law invites study by the aging and disabled as well as their advocates to determine how effectively the mandate to states has proven to de-institutionalize the nearly 20% of nursing home residents who express a desire to return to their communities.

Not only for their sake, but also to satisfy financial projections on costs to institutions versus community based solutions, we are obligated to find ways to expand access and care options to these ?imprisoned? residents whose sentence is now, since the ruling, due to the aging network's failure to prepare communities for the changes instructed by the top court in this country. That's us.

As an industry, we have failed to demand that the charge given to states be implemented. The demand for community-based living as a choice, regardless of a person's disability, will increase dramatically as we, the Boomer generation who demand ?choice? more loudly than previous generations, identify our own aging, where disease, disability and decline are more prevalent than when we were younger. It is more than a community issue and certainly will become our own personal issue as our own loved ones face a dearth of options to remain in at home if and when disability and lost independence rear its ugly head.

The funding and policy priority given states through passage of this Act has been largely lost in the political transition of so many newly-elected officials and so few people in the general community who are aware of this mandate -- and even fewer of them demanding results.

Funding more services to support disabled adults who want to return to their homes or move to new support-based residences must include expanded options of in-home, adult day, meal programs and certainly transportation services. These are the most obvious steps to enable an aging adult to seriously consider moving out of their current care facility.

In 2000, Florida became one of the only states to experiment with this concept. They successfully moved out 21 residents who had been in institutional care between one and seven years. This effort represented success in the realization of dreamed-for independence from institutional care, not only from the perspective of the newly residing community members but also from a financial standpoint.

Why then, did this extraordinary success fade by 2002, with only a handful of states successful in bringing together the teams of experts and advocates to address this work in their states?

Not only did the Olmstead Act pave the way for our institutionalized elderly to seek ways to reestablish their residence in neighborhoods, it also created a system for assessing the desires of nursing home residents to return home. Which states are using these assessments and making recommendations for community placement from them? Is yours?

Professionals working with caregivers whose loved ones are at risk of imminent institutionalization should explore what their state has accomplished relative to directives by the courts based on the Olmstead decision.

Picking up the ball again is in our industry's self-interest as we work to create the community of services that our present and potential customers will seek. I challenge each of us to pursue this effort to reignite the momentum, if it has been extinguished by a reprioritization of issues, certainly since the distractions of 9/11 and the war in Iraq.

Community rebuilding is occurring in Iraq, but what about our own communities and the rebuilding of services and support we have been directed to establish by the U.S. Supreme Court? Olmstead has laid the legal groundwork to establish and enhance care options for our loved ones and, potentially, ourselves. This will minimize the isolation and unnecessary removal from our communities as disability makes independent living more difficult.

We, then, have an obligation to pick up the ball and jumpstart the necessary groundswell and grass-roots energy to get funding for community-based care choices back atop the funding and service policies lists in our states. Advocating for this effort will not only demonstrate commitment to our communities' obligation to make fiscally sound choices, but also reflect our industry's mandate to provide care for the aging in the least restrictive environment possible. We owe it to our clients, our families and our communities.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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