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Reform Elder Care Now

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In his State of the State speech last month Gov. Gray Davis laid the cornerstone of his planned health care reforms this year--an “Aging With Dignity” initiative to “provide the services older Californians need to remain in their own homes, instead of nursing homes.” Specifically, Davis called for a $500 state tax credit to help the elderly finance home health care and for increases in wages paid to home health care aides, the people who help feed, bathe, medicate and otherwise assist people in their homes.

Davis correctly highlighted the elder care issue his predecessors ignored, but his policy falls short of the most needed changes. Under Davis’ plan, for instance, the current 4-to-1 matching grant given to counties for home health care aide salary increases would be reduced to 2 to 1. As Los Angeles County supervisors said in a recent letter to Davis, that reduction may actually dissuade counties from raising aides’ salaries, which now average about $6.25 an hour.

Most troubling, Davis’ plan sidesteps the lack of a statewide system for monitoring, credentialing, training and protecting the rights of the approximately 200,000 home health care aides who receive state and federal funds.

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So far, only the Service Employees International Union has addressed the failures of the state’s In Home Supportive Services Program, which in 1973 began funneling state and federal home health care dollars to counties, which hand out the money. The union, which last year won the right to represent Los Angeles County’s 73,000 home health care aides, has used the system’s failings to drive up membership.

But unions alone will not be able to resolve the sometimes conflicting needs of the aides, the elderly and taxpayers. Only legislators in Sacramento can help counties meet key challenges like these:

* Improving oversight of aides. Currently, the state lacks any system for doing criminal background checks on health care aides or for linking people with aides who meet their specific needs. In the early 1990s, the Legislature required counties to establish “registry and referral systems” to screen aides, but it has yet to fund the mandate.

* Improving quality of aides. The Legislature could help credential aides by passing a pending bill by Assemblyman Jack Scott (D-Altadena) that would direct the state’s community colleges, the California State University system and the UC system to offer basic health care training to aides. And to attract quality workers in the first place, legislators should offer subsidies to help aides get health insurance. It is not a little ironic that the people who provide basic care for so many Californians have no health plans of their own.

Most health care experts think the state can actually reduce health care costs by expanding and improving home health care. That’s because quality home health care can cut emergency room visits, which counties must pay for. It may also keep the elderly out of more expensive care facilities.

Assemblyman Gil Cedillo (D-Los Angeles) has promised to hold hearings this spring to outline state strategies for improving home health care. By making good on that promise Cedillo can turn the governor’s rhetorical commitment to improving home health care into reality.

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