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This past week a Frontline expose’ was shown on ALF’s. On the national listserv for GCM’s professional association (NAPGCM) a lively dialogue ensued. By and large, the response was nor approving of the show. The following was my own post:
Angel,
Thank you for a really well thought out written piece on the matter. I said I thought the show took on the quality of a hit job. You really made the case.
Having said that, I feel it pointed to important issues and concerns. Sadly, the framing of the show was to demonize the profit motive. Greed may well be a part of the matters cited. But, in reality, in a magical world absent greed, there’d still be the need for funding an endeavor. The issues that I feel are relevant here are:
1) Lack of access to many fore lack of money. There’s a real need for this service level. Plainly, offering a nursing home as the only alternative to living at home, because there exist public funding, is wrong. It is variously, excess service or incorrect service. Staying at home can be correct and most prefer this. But, that can also be obstructed due to lack of finance. Relying on the finances and services of family because “that’s how we always did it in this country” is wrong. It’s wrong because we didn’t actually do that. Also, family members didn’t spread like seeds in the wind of this huge country “back in the day”. And finally, the wealth distribution was such that families MUCH more typically had at least one person able to physically do the care.
2) Economically driven downward pressure on quality of care. The show did a very good job of showing evidence of this (“no back door”, keep the beds filled, staff shortages, etc…). However, it posited it as corporate greed. Firstly, we see these things in hospitals which are strongly funded by public sources (Medicaid, Medicare, etc…).Also, I find this finger wagging as useful as telling water not to flow down hill. We’re possessed in this country by a notion that however unregulated uncontrolled economic systems go is the best way for them to go. AKA the “magic of the marketplace”. Well, if I might continue (perhaps torture) my metaphor, water flowing downhill can flood, erode, fail to irrigate, fail to quench thirst, etc… So…, we build dams, channels, plumbing, etc… In our world that’s known by the dirty word “regulation”. We can solve a lot by stepping up to the plate and collectively caring through oversight. Rather than relying on the kindness of corporate strangers.
I think the best solutions are regulation and funding. Needless to say the trend in our country is the reverse. This is VERY sad. Virtually anywhere in the world where we see care thought superior to ours these are present. For example, in an ALF staff ratios could be mandated. However, they do need a certain amount of money to operate. So, let’s open up Medicaid/Medicare to fund. Will the institutions be like some of the Cadillacs we’ve now? Will Tony Bennett sing on weekends? Maybe not. Good enough is good enough.
So, why do I write to my colleagues about this? I know we’re all in private practice. I believe strongly in the value personally and collectively of what we do. I believe advocacy is cost saving in the bigger picture. We all want good high paying clients. But, from my first days in this profession I’ve been deeply distressed by the barriers to access of our own services that are sorely needed by many beyond who we serve. Many of us will take cases just to help but that doesn’t come close to the need. I would like us as a profession and organization to get behind insurers and public sources to fund us. Again, it won’t be the Cadillac service we usually deliver. But, it’ll be a huge improvement. Some of the tragedies shown in that documentary might not have occurred were we there at the time. We “stand in harm’s way”. I can say if I were receiving funding, I’d hire many more people and serve many more. Which would also help another little problem we’ve now: unemployment.
Thank you,
Mark (Zilberman, LCSW)
