[Congressional Record Volume 140, Number 17 (Thursday, February 24, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: February 24, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
FACES OF HEALTH CARE
Mr. FEINGOLD. Madam President, I rise to continue my floor statements
on the need for long-term care reform as part of the health care reform
effort.
I am proud to be part of an effort that we are making on the floor,
those of us who support health care reform and universal health care,
to portray in a very human way the faces of health care, the faces of
those who often do not get health care.
As I have noted in earlier statements, establishing consumer-oriented
and consumer-directed flexible benefits, as well as making fundamental
reforms to the linkages between the long-term care and acute care
systems, are absolutely necessary if we are to realize the goals of
health care reform.
President Clinton's home- and community-based long-term care proposal
goes further than any other in achieving this needed reform. It lays
the groundwork for creating a system of community- and home-based
flexible services that respond to individual consumer choice and
preference.
Madam President, I am proud to note that much of the basis for the
President's long-term care reform provisions flow from a program
established in Wisconsin in the early 1980's--the Community Options
Program, known as COP.
COP has been an enormous success by any measure. It has provided
long-term care consumers with an alternative to institutional care by
establishing a program of flexible benefits that are consumer-oriented
and directed. It has saved State taxpayers hundreds of millions of
dollars, and has been instrumental in actually lowering the number of
Medicaid nursing home beds being used in the State at a time when the
rest of the country was experiencing significant increases in Medicaid
nursing home bed use.
President Clinton's long-term care reform proposal can achieve the
same success for the entire country.
Madam President, more than any other group, advocates of long-term
care reform like to tell stories and give examples. Part of this desire
comes from the advocates themselves--people committed to helping
others.
But it also stems from the need to emphasize the uniqueness of every
long-term care situation, and to stress the need for a system that is
flexible enough and consumer friendly enough to respond to those unique
situations.
Recently I had the privilege of holding a field hearing of the Senate
Special Committee on Aging in my home State of Wisconsin. The hearing
was on the President's long-term care plan, and we invited a variety of
people to testify.
Madam President, I want to talk today about two of the witnesses that
appeared at the field hearing. Better than any list of statistics, the
story of these two people demonstrates both the promise of and the need
for long-term care reform.
First, let me tell you about a man named Robert Deist. Bob was left a
quadriplegic as a result of a bullet wound at the age of 14. He has
experienced just about every facet of the long-term care system. He was
institutionalized at age 15 because there were no community services
available to him or his family, and, at that time, his parents could
not afford to quit their jobs and provide him care in their home.
Eventually, though, at great financial loss to her family, Bob's
mother quit her job to take care of Bob at home.
Bob eventually went to college, got married, and is currently the
director of two personal care programs at an independent living center
in Wisconsin. He hopes to work until retirement age, but his wife is
his only caregiver.
Even though both Bob and his wife work, they cannot afford to pay for
a personal care attendant to come to their home and assist Bob with his
care needs. And because he works, Bob is not eligible for government
funding to pay for his daily care needs.
As Bob noted, in his testimony to our committee, his wife provides
his care 7 days a week, 52 weeks a year, every year, whether she is ill
or injured. If she were not able to provide Bob's personal care needs
for some reason, even for just a few weeks, their savings would be gone
and they would probably lose their home.
Bob and his wife live at the edge every single day of their lives.
As I mentioned earlier, Bob is the director of two personal care
programs. One of those programs serves long-term care consumers who use
Wisconsin's Community Options Program. So even though Bob actually runs
a program that uses COP funds, Bob himself is unable to get on the
program because it has a long waiting list. There are a lot of people
that need these services. Because of the huge demand for services, he
is unlikely to become eligible for years.
With President Clinton's long-term care proposal in place, Bob would
be eligible for services almost immediately. The very real threat to
Bob and his wife of imminent financial disaster would begin to
ultimately disappear, and he could begin to utilize the kinds of
flexible services available through the very program he runs.
Another long-term care consumer, Jettie Jones of Milwaukee also
testified before our committee. Her husband Launcelot has been a COP
recipient for 4 years.
Launcelot has been an active community advocate on behalf of seniors
for some time. Retired from the Department of Housing and Urban
Development, he is now in frail health, having heart trouble, is
visually and physically impaired, and is a borderline diabetic. Jettie
is not able to provide all the care Launcelot needs.
Launcelot was a classic candidate for a nursing home.
But because of the Community Options Program in Wisconsin, Launcelot
and Jettie have been able to remain together. As Jettie said, COP has
enabled them to maintain our dignity and our love and relationship as a
family unit.
COP provides Launcelot adult day care at Village Church in Milwaukee,
where he receives meals and socializes with others. COP also provides
transportation to and from the day care as well as transportation to
and from the doctor.
COP provides a personal care attendant who comes to the Jones home 4
hours per week, and a homemaker who helps Jettie maintain the home.
Jettie and Launcelot Jones are an example of what can be achieved
with a flexible, consumer oriented long-term care program. Without COP,
Launcelot and Jettie would not be able to live together.
Madam President, thousands of elderly couples like the Joneses are
forced to separate and impoverish themselves in order to get needed
long-term care services in the only setting available to them-a nursing
home.
Thousands of disabled consumers who could live and work productively
in a home or community setting are forced to live out their days
without that opportunity.
And thousands more like Bob Deist, who is able to live and work in
the community only while his wife is able to provide him care, live
with the daily threat that the least disturbance or misfortune could
bankrupt them in days or weeks.
In some of the most eloquent testimony I have heard on long-term
care, Chuck McGlaughlin, a county long-term care administrator,
testified at our hearing that prior to the Community Options Program,
elderly and disabled people had few choices. Unless they were wealthy
enough and had a sufficient natural support system to remain in their
home, they had no alternative but to enter a nursing home.
McGlaughlin noted that these people were torn from familiar places
and familiar people, an lost the continuity of their lives. While some
eventually adjusted to leaving their homes and communities, others
never did.
And some he saw simply willed their own death because they saw no
reason to continue living.
In contrast to the grim lack of choice for the elderly and disabled,
McGlaughlin recalled thinking that when he went to the grocery store,
there was an incredible choice available to consumers, even an entire
aisle for various types of pet food.
It seemed a sad reality to McGlaughlin that society has been doing a
much better job at providing meal diversity to cats and dogs than they
were doing at offering choices to humans facing frailty.
Madam President, I can and have made arguments on this floor about
the need for long-term care as a part of health care reform as a way to
control costs, as a way to ensure that our acute care reforms can work,
and as a guarantee that we can realize the goal of a reduced Federal
budget deficit. And I believe all of that is the case.
But, Madam President, to me the most persuasive argument for long-
term care reform is a human one.
We must provide our seniors and others with mental and physical
disabilities with real choice. They are entitled to the opportunity to
continue to live and contribute in the homes and communities they have
helped build and sustain.
Madam President, to conclude, I am very glad to have the opportunity
to join with other Senators in trying to show the faces of health care
and, in particular, that many of those faces are ones who need long-
term care.
I yield the floor.
Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The absence of a quorum has been suggested.
The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that I be
recognized to speak in morning business.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered. The Senator from California is recognized to speak for up to
20 minutes.
Mrs. FEINSTEIN. Thank you very much, Mr. President. I would like to
speak this morning on two subjects. The first involves a piece of
legislation I would like to introduce and the second an update on
legislation which the Senate passed and is now before the House.
(The remarks of Mrs. Feinstein, Ms. Moseley-Braun, and Mr. Simon
pertaining to the introduction of S. 1864 are located in today's Record
under ``Statements on Introduced Bills and Joint Resolutions.'')
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