If you are not sure what Return to Home legislation is, you are not alone.
In fact, the legislation, which helps ensure that elderly people in a managed health care program can return to their home community after hospitalization, is unknown to many members of Congress and many in the Jewish community.
But on Tuesday more than 3,000 participants in the United Jewish Communities’ Young Leadership Conference went to Capitol Hill to lobby for aid to Israel, hate crimes prevention laws, and — Return to Home.
How did this sleeper issue get to the top of the UJC agenda? And why now?
Even if health care choice for the elderly is not a hot issue, it nevertheless is an important one to the Jewish community, which has always been committed to the issue of access to long-term care for its elderly, says a UJC committee co- chair.
“It’s a disgrace when Jews can’t live out their lives in facilities that match their religious and cultural needs,” said Ellen Kagen Waghelstein, who helped select the lobbying issues and coordinated the Capitol Hill visits for the UJC.
Managed care organizations are accused of excluding facilities not on their provider list, including many Jewish homes. The UJC says thousands are affected by these practices, though no firm numbers are available.
Three bills before Congress include a provision to require any health plan that covers long-term care to ensure participants the right to return to their community of origin to receive long-term care services. Enrollees have that right provided the nursing facility can give the specific medical care and services required and the facility is willing to accept the same payment rate as the providers in the HMO’s network.
The last point should address the concern HMOs have of the legislation forcing them to incur higher costs. But HMOs likely are fearful of any federal regulation and may regard the Return to Home legislation as a slippery slope toward further government intervention.
Interestingly, the legislation does not actually mention religion at all and focuses instead on the policy of continued care in one facility. But religious groups have seized upon the issue and formed a coalition of faith based health care providers, run through the UJC’s Washington Action Office.
The coalition says it wants to ensure that religiously observant and religiously affiliated individuals are able to return from hospitalization to an environment that is consistent with their religious beliefs and practices.
Many Jewish facilities, particularly federation-affiliated agencies, provide kosher meals, religious services, holiday celebrations, Sabbath observance accommodations, trained staff and rabbis, and other aspects of “culturally appropriate” care.
The UJC gives a few examples of problems associated with lack of health care choice available to seniors.
One story tells of “Rebecca H.,” who lived in an assisted living facility on a Jewish retirement campus but was not allowed to return to the campus following her hospitalization. She was sent to a different facility, but was unhappy away from her familiar environment and friends.
Although she is happy to be back at the Jewish home, she must now use her remaining financial assets to pay for her health care.
Kagen Waghelstein says the UJC conference participants represent a bridge generation and the legislation affects their grandparents, the last generation of Holocaust survivors. Though there may not be a sense of immediacy on a personal level for many of the young leaders, she believes the issue will resonate with them.
“We’re not the `me’ generation,” she said.
Once briefed, conference participants indeed seemed motivated to pass on their education to their representatives and senators in Congress.
“I’m shocked,” said Ron Moses, a doctor from Houston. “The federal government even provides ritual practice needs in prisons.”
Moses believes that people who live near their family and friends and in comfortable surroundings will live longer and healthier lives, thereby cutting the long-term costs for managed care organizations.
“HMOs are being short sighted,” he said.
For Elliot Rubinsky, the legislation truly “hits home,” he said, because his grandmother had to be put in a Baptist home, where Rubinsky said her religious needs are being neglected. While he didn’t know about the legislation before the conference, he thinks it’s important for the sake of people from all religious backgrounds.
The impact of thousands of Jewish constituents lobbying their congressional representatives on an unfamiliar issue could work to the lobbyists’ advantage.
Rep. Robert Wexler (D-Fla.) may be more aware of the issue than most representatives considering the large percentage of elderly citizens in his district, and he says some members of Congress need “a bit of an education process” on the issue.
Wexler predicts there will be tremendous changes in health care policy over the next several years and said if “Return to Home” doesn’t succeed now, at least elements of it should be incorporated into whatever health care legislation will pass.
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