I think that no matter what state policy is, nursing homes rule. Too many people make their living this way. It's just that in individual states, there may be rules in place – as there are in New York, for instance Consumer Directed Care – which people on Medicaid can utilize to avoid living in nursing homes. But too many times, restrictions in the acquisition of medical equipment contain the message: "if you need this equipment, you belong in a nursing home." For instance, Medicare/Medicaid will not supply a fully automatic bed. Nor will they supply a power assist Hoyer lift, or ceiling lifts. Once I had a physical therapist who questioned Medicare about a Sure Hands ceiling lift for me. She was told, by Medicare, that any piece of equipment (other than a wheelchair) with a motor was considered a "luxury." (!)
When the federal government will spend twice to three times the amount of money that it takes to keep people in their homes on putting them in nursing homes, then obviously the economics of the situation have no meaning. Virtually no person in a nursing home is there without the assistance of Medicaid. The families of people have to go through a spending down process in order to qualify their relatives for Medicaid. My experience of a nursing home taught me that nursing homes truly are the dumping grounds for people that our society would prefer not to acknowledge, and that they truly are institutions, every bit as much are hospitals and prisons. It's not that nursing homes are all bad, at least the one I was in wasn't all that bad. It was like anything else – there were good parts, and bad parts. I learned a lot there, and I met a lot of good people. All the same, I'd rather be home.