Back in 2011, labor liberals in the Lehigh Valley made a big issue out of keeping Gracedale, the public nursing home, under public ownership. Mostly this was a union issue, but proponents led with a lot of (bad) arguments about how only public nursing homes could protect the dignity of low-income seniors.
Actually, community care – caring for people in their own homes – is the best and cheapest way to provide dignity and comfort to seniors and people who are not going to recover from a terminal condition. Ask anybody if they’d prefer to spend the end of their life in their home or get institutionalized, and I bet nobody picks the nursing home.
But to date, Medicaid hasn’t covered community care. Things have been slowly shifting in the direction of home care, since it’s cheaper and better, and declining reimbursements for nursing homes (and particularly county-owned homes) have left a lot of these places in the red. Obamacare is going to make things worse for the nursing homes, but better for patients.
Some liberals I know want to have a big fight about this with the state and federal government, but that’s nuts. Community care is better! Increasing coverage of community care is more humane, is cheaper, and is less paternalistic. People should be able to get in-home care if they want. That’s the real progressive position.