This afternoon the Call-a-Bus driver was commenting on my shiny new electric powered wheelchair. The undertone, of course, was that I didn’t need it and she shouldn’t have to pay for it through her taxes to Medicaid and Medicare. She also asked about aides, saying she wondered how they got paid.
For us poor people—which is most of us who are disabled—aides are paid for from Medicaid funds. Six months ago, I was getting aides about three hours a day, seven days a week. An aide gets paid about $8 an hour. Conservatively, the aide agency probably charges $12 an hour, so it is billing Medicaid about $250 a week, or $13,000 a year, for my care. (My annual income from Social Security Disability is less than $8000.)
Because I moved into a wheelchair accessible apartment, which means that I can get a wheelchair under the kitchen counters, sink and stove, I can “do” for myself much more. I can do a lot of my own cooking, and I can wash my own dishes. You cannot imagine the joy I get from washing my own dishes. There I am, up to my elbows in hot soapy water, singing to country and western music on the boom box, and grinning.
For four years, I have had to tolerate aides washing my dishes. I don’t know why aides do such a poor job of washing dishes—maybe young women have a lesser sense of “clean” than what I was raised with, or maybe it’s a cultural difference between middle class white and lower class black, or maybe they just don’t care—“It’s a job; get it done any which way.” I wonder sometimes what degree of cleanliness they apply to their own dishes at home, but I get damn tired of dirty dishes.
There are aides who pay no attention to grease; they wash off foodstuff, but leave behind the sheen of grease. Some aides wipe the wide spots but don’t wash the edges, for example, where plastic lids fit plastic bowls. Some aides are just slobs; I ate chocolate ice cream out of a white bowl and when I took the bowl out of the dish drainer the next day, it still had brown streaks on it. One gets a little temperamental over time. Forks with egg still on them. After while you give up, and just use dirty dishes.
I gave the matter of dish washing some considerable thought and realized that I washed dishes by touch; if my fingertips felt nothing, then the dish was clean. Some aides wash dishes wearing gloves. Ponder that for a while. You can’t get it clean if you can’t feel it or don’t look at it. So I’ve had dirty dishes for four years.
Periodically, when things have been good, I’ve tried to stand to wash dishes but the arthritis pain in my lower back tends to make me scream after about five minutes. Now I have a wheelchair accessible kitchen, and an electric wheelchair. (The manual wheelchair was so much lower than the power chair that I was washing dishes with my elbows raised to my ears.) With the power chair, I can wheel around my kitchen and cook. I get pretty tired, but I’m doing more of my own cooking every week.
The bottom line is this: in large part because of my power chair, I have reduced my aide hours from 21 per week to 8 per week. That’s an annual savings to Medicaid of $8100. The power chair costs $7800—and will last at least five years. My power chair is saving the system—the taxpayers!—about $43,000 over five years, so here’s my plan.
At the local level, put brokers into the Medicare/Medicaid systems. Empower the brokers to authorize rational tradeoffs. The consumer will submit a letter to the broker saying how payments for one thing will reduce payments for another thing. The broker does the math, approves it, and initiates the paperwork to pass up the line so that M/M pay for it. The broker doesn’t investigate, negotiate or any other thing; if necessary, s/he sends a form letter back to the consumer checking off what additional information is needed (i.e., copies of benefit statements, estimates by providers, etc.). There will be no appeal process, but the consumer can resubmit the request at any time.
My prosthodontic work would have cost (who remembers now?) about $4000 on the local market at full value. Eastman Dental Center in Rochester would have accepted about $2000 as full payment from Medicaid. Medicaid wheelchair transportation from Syracuse to Rochester was going to cost $3000. I could have saved my energy and $1000 of the taxpayers’ money by paying full price to have the work done locally. All it needed was a broker to authorize the transfer of funds.
Medicare will not pay for power chairs for use outside the home. I live alone in a two-room apartment. A power chair costs $7800. Inpatient treatment for depression costs $600 a day—less than two weeks in the hospital equals the cost of getting out of the apartment. Additionally, I use fewer aide hours and need less time from case management if I can take myself to the store to buy my own underwear.
I am also much happier. We cannot figure that into the equation because it is priceless—but a happy person is also a healthier person. Happiness engenders hormones and neural impulses and such other stuff that make a person healthy, so when the broker figures the costs, lets put in the X amount—an estimate of how happy you will be with dentures that look good and don’t hurt, for example.