Thursday, October 31, 2013

Obama now seeks to have the Feds control the home health care market - another big debacle on the way?

President Obama now plans to extend control of home health care workers to the Federal bureaucracy and technology wizards.  Apparently he can do this by executive fiat, as from what has been read here, it seems like a done deal, set to begin in on January 1, 2015.

Home care of the elderly and disabled is a big issue that is getting bigger year by year.  Why states cannot handle this regulation and communities not be full fledged participants in its implementation in their areas is not understandable.  Obama has now extended minimum wage and overtime "protections" to what is estimated to be two million home care workers.  Sounds fair on the surface, but an ad hoc working system for this difficult, very difficult, issue is already in place and Obama's never ending federal government reach will blow it out of the water.

Most adult Americans need no primer on this issue.  They have seen it in their families.  The community based ad hoc system that works better than anything the Federal government will impose is one based on many home health care aides being groups of independent contractors.  Their roles vary widely.  Certainly there should be protected in some ways and there are rules in almost every state, maybe every state, that make it a crime to abuse home health care workers, treat them as slaves imported from other countries, or otherwise force them to play their role.

As independent contractors they are running their own business and under the Obama proposal the elderly and disabled will end up being the employer who plays the business role.  Is that really possible?  Maybe, but for many it may be only if they hire generally expensive large service providers with limited reliable personal touch( those bigger companies provide bodies, not  relationships), something that many can't afford, would exhaust their funds, and then would send them to many of the woeful nursing homes that exist where they would live out their lives in complete boredom with bad food and away from the homes that they have lived in and are familiar with.

Are home health care workers exploited as the all knowing Obama implies.  The guess here based personal experience, and observations of many other situations, is not generally, not generally at all.  Many receive an hourly wage above the minimum wage, they can arrange flexible hours, and are often obviously given the money to be buyers of the food they can cook and eat what they choose while making sure that their client is as well.  The situation is so difficult that most home health care aides are highly valued.  As they build  a relationship with a client they can at times receive perks or gifts or needed financial advances.

These are in many areas coveted jobs.  Think about it this way.  While they certainly have serious responsibilities and at times deal with out of sorts or sickening clients, they also often have lots of free time.  Most elderly and disabled are not exactly running around out of control.  Depending on their condition they may read, watch television, help prepare meals, and sleep more than a healthy younger individual.   The sicker individuals will be taking medication and often sleeping more.  Some will have sleeping problems and this is more difficult but often treatable with medication.

Personal experience has seen responsible caretakers who are part of a 24 hour coverage regime.  One would come in at around 6pm, spend time with their client and maybe drive him out to a joint restaurant dinner, or warm up some take-out, and then go through the slow ritual of getting their charge to bed.  Their client, actually my father, would call out maybe two or three times a night with a need for help to get to his walker safely and go to the bathroom, but otherwise the caretaker could watch television, mostly all sports, until he was tired and then sleep for most of the evening excluding those few interruptions.  Is this a 12 hour day under Obama's approach, requiring overtime and Federal oversight?  The caretaker could go home in the morning, see his family, go about his home repair job, and maybe take a short afternoon nap at some point although he claimed to never need one.

Whether an elderly person is incapacitated marginally or completely, they do need care and much is provided by family members if available, but with the dispersion of jobs across the country this is not the 1950's anymore.  Family members are often not immediately available, or if available not necessarily so healthy themselves, and at times they are outlived.  Neighbors and friends cannot take on the burden of full time health care although they can be and are at many times godsends as visitors and helpers for an elderly person's needs.  Put this Federal control system in place and it will quickly drive many people out of their homes, out of their savings, and into Medicaid institutions.

I have had first hand experience with one of those institutions on Long Island in the last year.  It was and is Peninsula Center for Extended Care and Rehabilitation in Far Rockaway on Long Island.  The Rehabilitation part is advertised as a center for physical therapy which I had some need for at the time and doctors at North Shore hospital insisted that I go there or I would not have completed treatment and they would not file for my insurance claim.  What a lame and arrogant threat I think that was, as if it was in their power, but I followed their advice and went.  Maybe it would be helpful.

What I found was a large decrepit former hospital that had been turned into a Medicare and especially Medicaid scam organization.  I was there for four days and received 15 minutes of physical therapy in total.  To use the old Woody Allen joke about a complaining Catskill's visitor, "the food was terrible and the portions were so small".  This was not a joke at Peninsula. For one dinner I opened the ubiquitous hospital plate cover and there was the equivalent of one scoop of macaroni and cheese.  At this point I was already quite vocal about my treatment and in a hostile way I was told that my food what everyone else received. I could go on and on about what a dump this place with broken furniture, non-responsive workers, and how hostile the mostly west Indian island nurses aides were if asked to do anything.

I saw some of the abuse of the elderly on my floor the few times that they let me out of my room(I was like a prisoner there), but there were three floors above me that were all extended care.  The only person who told me the truth about the place was the worker who cleaned my room each day and he had been working there for 17 years.  He explained that until three years ago it had been a well regarded full service hospital for the community but somehow its placement and financial condition led to it being sold to  a group of corrupt Hasidic Jews.  They fired 200 people, cut back on any quality food, and let the place deteriorate while packing it with Medicaid recipients.  Why was there not some oversight of this.  Who knows?  This is Long Island so payoffs just might be the answer but that's just speculation.  In fact the place should be closed and the owners charged with crimes.

The point of all of this is that Obama's desire to insert itself into the rigid regulation of home health care will do much more harm than good.  That's the opinion here and it is a strongly held one.  Everything does not need be run from Washington, and communities are smarter, more resilient, and more caring than the strangely elitist Barack and Michelle Obama give them credit for.

At this point there is a part of me that hopes there will be an excuse to gets impeach Obama before something like this actually takes place. That's not likely and not a wise suggestion but he is just too arrogantly blind on so many issues at the moment that I am losing perspective, and admit it.

I should say no more. 


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