Medicaid Cuts Based on Elderly's IncomesWe are...

THE BALTIMORE SUN

Medicaid Cuts Based on Elderly's Incomes

We are writing in response to Laura Lippman's Oct. 21 article "Medicaid cuts would hit elderly."

As the co-chairs of the Joint Administrative, Executive and Legislative Review Committee (AELR), we would like to take exception to the last paragraph which stated, "The Administrative, Executive and Legislative Review Committee is expected to act on the proposed regulatory changes in early November, clearing the way for the cut to take effect Dec 1."

As emergency regulations, the AELR Committee must vote affirmatively before the regulations become effective.

Should the committee not approve these emergency regulations, then, and in that event, the Department of Health and Mental Hygiene may choose to proceed with proposed regulations (which do not require AELR approval) which will take at least 90 days to become effective. In the latter case, of course, the date of Dec. 1, 1992 becomes inoperative.

Your readers should know that the AELR Committee has no statutory authority to negate this budget cut proposed by the governor and the secretary of health and mental hygiene. The committee may only delay its implementation by declining to approve the emergency regulations.

Sen. Paula C. Hollinger

' Del. Kenneth H. Masters

Your story on the Maryland Medicaid cap on nursing home resident incomes had at least two misleading statements and certainly minimized the human cost of this proposal.

To refer to the income of the Medicaid recipient as "earned

income" is technically incorrect. This income is from Social Security and pensions.

Milo Polchop, with a monthly income of $2,200 from SS and a pension, is an example that, as presented, implies that he receives almost enough to pay the private pay rate. It is highly probable that nearly half of his income goes for spousal support under the spousal impoverishment provisions of Medicaid regulations.

Now, let's get to the human pain involved here. Secretary Nelson Sabatini of the Department of Health and Mental Hygiene suggests day care or other alternative arrangements. Mr. Sabatini should know better.

The reality is that the people who are threatened can't go to day care because they need nursing care 24 hours a day. They are in a nursing home because they deteriorated to the point where they need a level of care greater than day care.

More than half the persons affected in the four southern counties of the Eastern Shore are certified as "heavy care" by the Delmarva Foundation, which assigns a level of care for Medicaid reimbursement.

I am certain that Mr. Sabatini knows what heavy care is in clinical terms. If you don't know, heavy care is this: These persons cannot feed, toilet, dress, bathe themselves or move purposefully.

They require a number of medical procedures such as gastro-enteral tube care, injections, catheter care and turning to prevent decubitus development.

Even intermediate and light care residents are often more than families can care for because of the behaviors associated with dementia. The level of care assigned is misleading if you think it indicates that families could care for these people who wander, scream every waking hour, sleep only intermittently and who are often violent.

The nursing home administrators who said they would absorb the cost should have been identified by facility and by type. I suspect they were church supported or have an endowment.

Most facilities, even private non-profits or county-operated homes, simply don't have these kinds of resources behind them.

This is a complicated issue that is not helped by simplistic statements or judgmental remarks.

And most importantly, older persons who are demented and/or very sick with medical conditions, cannot be cared for at home. And they and their families do not deserve to be frightened and destabilized by threats like this.

Yes, Maryland does have budget problems. But cutting services that mean the difference between life and death, services that guarantee a dignified existence for old people, is not the way to go.

Let's look at services that are optional. Let's defer more highways and bridges to vacation areas. Let's not build stadiums and subsidize the wealthy.

There are places in this world, Scandinavia for one, where it is safe to grow old. If we really want to say with truth and with pride that we're proud to be Americans, let's put our money where our mouth is and make this a safe place for all citizens, not just for the wealthy.

This proposal, if implemented, is cruel to families and nursing home residents. I find it unthinkable that our state leaders could even contemplate this.

If you agree with me, call your legislators. And call your local office on aging. I have no doubt that they are organizing a campaign that will make the governor, the legislature and all the citizens of the state pay attention.

Sandra Poole

Salisbury

Gays Advocate No "Radical Sexual Agenda

As a leader of a major service organization within the local gay and lesbian community, I am compelled to respond to two letters in the Oct. 24 Saturday Mail Box.

One addressed coverage of the NAMES Project AIDS Quilt display in Washington; the other expressed a more generalized "opposition to homosexuality."

Rarely does the occasion arise in which hatred and misunderstanding felt by many against gay, lesbian and bisexual people become so blatant and self-admitted.

While painful to read, these letters were instructive. Several responses are in order.

Like the African-American community, persons addicted to drugs, hemophiliacs and babies of persons infected with HIV, the gay and lesbian community did not cause the AIDS epidemic. Like them, we have suffered tragically because of it. And we have risen to the task.

Ironically, it is the gay and lesbian community which has led this ++ society (initially kicking and screaming) into developing public health responses to this horrific epidemic.

Ours is the only population group as a whole which has educated itself and brought about dramatic decreases in the rate of new infections.

While we are aware of more work to be done -- especially with regard to younger gay and bisexual men and men of color -- we are proud of what has been accomplished.

It's too bad some don't share the compassion and courage we have been called upon again and again to demonstrate.

Both letter writers seem to have allowed their prejudices to get in the way of facts.

It is true that homosexual orientations express themselves differently in various cultures. However, that does not mean that homosexuality (or heterosexuality) is chosen or culturally produced. Any anthropologist or developmental psychologist knows that. Nor does it mean that homosexual or bisexual persons are inherently "out of control," "anti-family" or doomed to "long-term heartache."

The truth is quite contrary.

Many of us live in committed, fulfilling, long-term relationships. We faithfully work our jobs, pay taxes, go to school and volunteer in religious organizations or community service projects -- just like everyone else.

Some of us have committed ourselves to raising children, either because of previous heterosexual marriages, because society needs loving people to be foster and adoptive parents or because we simply want to.

Others care for aging or ill relatives because heterosexual siblings have their own family obligations which make such caring difficult.

We do all of this gladly. Such behavior is what it means to be part of a humane and just society.

Of course, the religious right wing will showcase its self-anointed experts claiming otherwise. These people will skew their research, trot out extreme personalities and cite anecdotal stories to establish their point.

Lesbian, gay and bisexual people know better than to judge the entire population of heterosexuals because, for example, 90 percent of child molesters are heterosexual or because heterosexual women are one of the fastest growing population subsets becoming infected with HIV.

We are not advocating "special rights" or a "radical sexual agenda." All gay, lesbian, and bisexual people are asking for is to be treated with dignity and fairness.

What we want are five things: equal protection under the law, support and recognition for our families, an end to the threat of government intrusion into our private lives, respect for who we are and the chance to participate in creating a prosperous and just society.

John Hannay

Baltimore

The writer is executive director of the Gay and Lesbian Community Center of Baltimore.

Volunteers Have to Follow Prison Rules

I am compelled to respond to your Oct. 21 article about the Maryland Correctional Institution for Women. This article portrayed the agency as indifferent to its volunteers and insensitive to the defined needs of a group of inmates. This is not the case at all.

The Division of Correction has committed a significant amount of energy and effort to the development of a viable program to encourage a broad base of voluntary activity in support of inmate needs.

The program is built upon a set of guidelines which integrate the role of volunteers within a structure established for safe and secure management of the prison. All volunteer program proposals are evaluated and developed with each volunteer agency and form a mutually agreed upon contract. From the beginning, both sides have agreed to the parameters within which the program will operate.

Surprises do not work well in prisons. In the case of Unity, the article presents one point of view and only part of the information.

It is not my purpose to tell the rest of the story, but rather to capture the essence of the issue which truly needs to be addressed.

Prisons exist to maintain individuals who have broken the law. Rules exist for the order of prison society, and inside the walls it is required to adhere to the rules and effect constructive change by working within the system. To do otherwise is to enable anarchy.

That gets us back to Unity. In this case, the organization failed to respect our agreement, and the warden attempted to resolve the issues consistent with the approved program.

When Unity declined to engage in that dialogue, the group effectively terminated the agreement. This was its decision.

However, the division has not abrogated its responsibility and recognizes the need for services to battered women. Toward this end, the division is in the process of identifying other community resources to re-establish the program.

Managing prisons with limited resources is a challenge. Volunteers are more essential to our success than ever before.

However, the responsibility for any program is shared, and the integrity of the program must be assured by all who participate.

Merry Coplin

Baltimore

The writer is deputy commissioner of the Maryland Division of Correction.

School Libraries and Librarians

The element that is often missing in discussion of library staffing is that librarians differ by training, according to library type.

School librarians are certified teachers, most public librarians are not. Hence all librarians are not interchangeable.

Because school librarians are teachers, sending high school librarians to elementary schools, or vice versa, is not feasible since, like all teachers, they are certified for specific grades.

Most high school teacher-librarians are certified (trained) only for high school and therefore are not eligible for the elementary level -- just as most elementary teacher-librarians are certified only for elementary level.

Additionally, sending all librarians to the elementary and middle schools only serves to solve one problem by creating another, just as bad or worse.

Stripping the secondary library of professional staffing is abandoning the older students precisely when they are fine-tuning their research skills -- skills vastly needed in today's information-rich society.

We ask too much of today's teachers as it is. Must they be librarians, too?

School libraries are where the love of reading can be born and nurtured into fruition. Because school libraries have captive audiences, an unparalleled opportunity exists that benefits all, including public libraries. School libraries are the training ground for future public library patrons and better informed, more capable citizens.

When a school has a library, a teacher can bring a class to the library providing an opportunity that the public library, no matter how close, cannot provide -- that of trained teacher assistance, teamed with a trained school librarian (who is also a trained teacher).

And as heretofore mentioned, the public library does not have the benefit of the captive patron as the school library does.

No matter how close a public library is, you cannot guarantee that students will actually go to use it. However, unstaffed, understaffed, unstocked school libraries nullify this potential.

If students are not using Baltimore's school libraries, it is because the libraries are not properly and adequately staffed or stocked with current, interesting materials (probably both).

I can assure you that if you have what the students want to read, the school library will be used, and if you have up-to-date materials that support the curriculum, the teachers will see to it that the students know and use these materials.

I disagree vehemently with the statement in your Aug. 23 editorial: "Educators agree that if students don't gain an interest in reading and using libraries at an early age, it may be too late."

If it is too late, it is because we have given up on them. This is one educator who feels strongly that this is an easy out for not staffing and stocking high school libraries. Granted, the older student is much more challenging and requires more concentrated effort. One-on-one is extremely important, requiring adequate and properly trained staffing which, as The Sun pointed out, often does not exist in Baltimore.

Just as most school teacher-librarians are not interchangeable between grade levels because of specialized college training and state certification, neither are school teacher-librarians interchangeable with public librarians.

Most public librarians are not certified (trained) teachers with a major in school librarianship defined by grade level -- just as most school teacher-librarians are not trained, qualified public librarians with a major in public library service with an ALA (American Library Association) accredited master's degree.

I hope The Sun continues to facilitate a dialogue for the revitalization of our beloved Pratt, which serves the whole state through inter-library loans.

However, it should not be done by raiding school libraries of their human professional resources. As often happens, the search for answers in one area has served to bring to the forefront a similar problem in another area -- that of vastly inadequate staffing in Baltimore school libraries.

Ann Cober Reed

Easton

The writer is library media specialist at Colonel Richardson High School, Federalsburg.

Aral Sea Disaster

As with the post-Chernobyl conditions, there is a desperate need to help the regions around the Aral Sea, ecological disaster areas very much in need of an international medical center.

I feel it is my duty to my colleagues and professional friends as well as to your readers to report on the tragedy of the Aral Sea peoples. Your July article with its accompanying photographs of the sick children has driven me to write this letter.

My home is in Tashkent, Uzbekistan, near the Karakalpak Autonomous Region of the Aral Sea, where I journeyed in 1965 in my role as a physician to assist with the cholera outbreak going on there at that time.

I returned to this region in 1985 as a member of a medical team sponsored by the Communist Central Committee of the Republic of Uzbekistan to review the general health conditions of the population.

This second visit allowed me to make comparisons with my initial trip. At that time, despite epidemics, the people there could fish, garden and do handicrafts. There were some green areas. In 1985, the encroachment of severe desert conditions had exacerbated the existing poverty and poor air quality.

When we did the medical checks, we could see into the houses. These consisted of empty rooms, crude utensils, no furniture. The whole family slept under a quilt on the floor. Primitive conditions prevailed.

Our medical examinations showed 90 percent of the women in the age range of 17 to 35 were suffering from severe anemia as well as stomach, bowel and liver problems.

The children were pale. Many were physically and mentally retarded. They looked like little old men -- such a heart-breaking experience!

Your 1992 photographs reveal that conditions have not changed. Many people need medical attention and medicines that the 1985 trip of the medical team could not provide during its two-month investigation.

I do not know how many children and adults have died since 1985, but I would guess that the numbers are large and are continuing.

Although informed about the Aral Sea ecological catastrophe, the world is not sufficiently informed about the severe health problems extant throughout the region.

With medical assistance many lives can be saved, especially those of the young children. The situation is urgent. I see the need of an international medical center as a means to assist the Aral sea peoples. I hope this letter will prompt a response.

Benjamin Gronas

Baltimore

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