Grow Old with Me.

If you're asking how we can help the elderly without nursing homes and similar institutions, my friend LDP has the answer.

They stay in their homes with community supports. I help run a company that does this for people with developmental disabilities and it can easily transfer to the elderly community. In fact, there already is a program in Indiana that does this through the Aged and Disabled Medicaid waiver. Nursing facility lobbyists don't want community supports to happen because it means that they lose profits. They push institutionalization instead. Every Medicaid patient is "worth" $83,000 a year to them. Community supports can be done at that rate or even less. We have made it seem like nursing facility placement is the only option and this is patently untrue. I am not disparaging nurses or CNAs at all. Keep them; lose the facility.

I hope he doesn't mind me quoting him. This article seems to be an excellent introduction to the topic. I recommend reading the entire essay. It will make you think long and hard.

It’s Time to Abolish Nursing Homes, by Sara Luterman (The Nation)

If three out of four Americans want to spend their final years at home, why do so many of us end up in institutional care?

 ... Nursing homes allow for an economy of scale. Feeding, washing, and otherwise seeing to the needs of elderly and disabled residents all at once is more efficient than addressing those needs on an individual basis. But this efficiency comes at the expense of human dignity. Ari Ne’eman, a senior research associate at the Harvard Law School Project on Disability, points out, “From Grandpa Simpson to Junior Soprano, popular culture constantly acknowledges our society’s worst-kept secret: Nursing homes are awful places to live.

Unfortunately, we’ve set up our health care and human services systems to send vast numbers of seniors and people with disabilities there anyway.”

That leaves us with a few basic questions: Why do nursing homes exist? How have they so thoroughly embedded themselves in the American life cycle? And what can we do instead? ...

Hagiography: In quintessence.

A very nice bar, and not high at all. It's the 3rd and Main in Aurora IN

Merely an observation, and no reflection on disagreements (and agreements) now floated downriver; neither of us appears to be going anywhere, and relations have been good. I'm only trying to recall a local elected official in my memory capable of inspiring sheer, pubescent swooning in the manner that Rep. Clere manages. It is a strange and periodically chilling phenomenon, and we've noted past examples in comments sections and letters to the editor. The following dichotomy is perhaps the clearest instance to date.

First, the newspaper's Chris Morris, hardly a neutral figure in such matters, and perennially prone to fawning in proximity to his elders -- except that Morris is chronologically older than Clere. Still, he manages to keep it somewhat in check.

CHEERS

... To Indiana State Rep. Ed Clere, a Republican, who said his party has become a stumbling block to extending health care for low-income Hoosiers.

States were given the option to expand Medicaid coverage under the Affordable Care Act, and Indiana Gov. Mike Pence and Republican leadership decided not to do so. While most elected officials go along with their party leadership on almost every big issue, Clere stood up and called state Republicans out on this important issue.

It shows that he is standing on his own principles and is doing what he thinks is right, instead of rubber-stamping the Republican talking points.

— Chris Morris, Assistant Editor

Fair enough. The dullard Pence and Indiana's GOP leadership have been a disgrace, and I'd taken note of Rep. Clere's comment, too. I hadn't gotten around to doing anything with it, primarily because I wanted to do some further research first, and time has been elusive lately.

Fast forward a week, and then this:

CHEERS

... to the Cheers by Assistant Editor Chris Morris that appeared in the Nov. 2-3 News and Tribune.

We need more politicians like Ed Clere. As a matter of fact, we need more citizens like Ed Clere. As Chris stated, while most elected officials go along with their party leadership on every big issue, Ed stands on his own principles and says and does what he thinks is right. Ed uses common sense when forming and explaining his principles. What a concept. We should all learn from Ed.

I have known Ed for several years. He has always exhibited the finest qualities. First, Ed is always a gentleman, polite and courteous no matter to whom he is speaking; second, he is always fair and ready to discuss any topic, give his opinion and listen to and consider mine; third, he is always willing to volunteer his time for whatever is needed, whether it be to coach a soccer team or sell ears of corn at Harvest Homecoming; fourth, he is everywhere, whether it be at a state event in Indianapolis, a local fundraiser sponsored by philanthropic groups or at our local farmers market shopping for his family; fifth, he is an excellent role model for our youth.

The bottom line is we need more Ed Cleres in this world. So, thanks Ed, for setting the bar so high. Too bad most of us will never reach that level. I am honored to have you as a friend and will never refer to you as a politician.

— Debbie Webb, New Albany

That's just plain weird, and I'd like to add than many of us set the bar quite high -- but never so high that you can't see over it when occupying your favorite bar stool.

Some things go beyond politics, right?

The Stutzmans, Zoellers and Pences bleat and wail.

And that's good enough for me.

Indiana Planned Parenthood declares victory after Supreme Court declines to hear funding case, by Jill Disis (Indy Star)

The U.S. Supreme Court will not disturb a lower court ruling that blocks Indiana’s effort to strip Medicaid funds from Planned Parenthood because the organization performs abortions among its medical services ...

... The law would have also defunded family planning programs throughout the state.

“We are happy that the Supreme Court’s action lets stand the Appeals Court ruling that the state does not have plenary authority to exclude a class of providers for any reason,” said Jane Henegar, executive director of the ACLU of Indiana, in a statement issued Tuesday. “Federal law protects the right of Medicaid patients to choose a health care provider free of interference from the state.”

The Clere Channel spins out. Again.

In his most recent News and Tribune column, State Representative Ed Clere attempts to provide himself political cover for supporting House Enrolled Act 1210, the plan to defund Planned Parenthood via a change to state Medicaid restrictions. As is often the case, Clere admonishes that "we should stay focused on facts" but then only includes a small, cherry-picked sample of them in an attempt to obfuscate rather than educate.

Clere points out that Planned Parenthood in Floyd County receives only $673 a month in Medicaid funding while other clinics providing Medicaid services here receive a comparatively much larger monthly average of $17,130. Via this incomplete logic, we're supposed to believe that defunding Planned Parenthood is of little consequence to Floyd County or the state.

What he conveniently fails to mention, though, is that HEA 1210 puts Indiana at odds with federal Medicaid funding law. As explained in a letter from Center for Medicare and Medicaid Services Administrator Donald Berwick to state officials, as a condition of receiving federal Medicaid funding, "Medicaid programs may not exclude qualified health care providers from providing services that are funded under the program because of the provider's scope of practice...Therefore, we cannot determine that the proposed amendment complies with section 1902(a)(23) of the [Social Security] Act." In other words, non-compliance with federal law could put the entirety of Indiana's federal Medicaid funding at risk.

It is no surprise to legislators like Clere that this is the case. In an April, 2011, Fiscal Impact Statement (PDF), Indiana's Legislative Services Agency informed the legislature that "The Family and Social Services Administration (FSSA) reports that federal law requires state Medicaid plans provide any eligible individual medical assistance and that they can obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service(s) required. This also includes an organization which provides such services, or arranges for their availability, on a prepayment basis. Federal law permits states to define a qualified provider, but requires that this definition is related to a provider’s ability to perform a service and not what services are provided." Further, the LSA predicted the bill would have no fiscal impact on Indiana precisely because federal law would prohibit its implementation.

In 2010, Indiana's federal Medicaid funding amounted to approximately $4.3 billion, roughly two-thirds of the state's $5.9 billion Medicaid budget. The fact is, an overwhelming majority of the state's Medicaid funding has been jeopardized by Clere and other legislators well aware of the risk, not just six or seven hundred dollars a month for Floyd County's Planned Parenthood clinic as Clere's column suggests. If their obstinacy persists, the result could be a drastic cut to service access in Floyd and other counties as federal Medicaid funding would disappear. To use Clere's example, Floyd County's approximate $18,000 per month average, cut by two-thirds, would be reduced to about $6,000 total, a situation replicated all over the state in larger, more populous counties.

So, indeed, let's "stay focused on facts", but all of them.