A major reason for enacting health reform is the fate of elderly and disabled patients—especially the indigent—in nursing homes and assisted-care facilities.

Except for the visits of relatives and thoughtful friends, they’re out of sight, out of mind, all but ignored by politicians and media tuning up for President Barack Obama’s health care summit Feb. 25. But nobody is affected more by the confluence of the health care stalemate and the recession than these patients.

Care for roughly two-thirds of the almost 2 million in these facilities is paid for by Medicaid, the federal and state government aid program for those with low or no income. The stalemated health reform bill would extend Medicaid to cover more people. Another provision would create a federal long-term health insurance for the disabled, with benefits of $50 to $100 a day.

Meanwhile, many states, their revenues reduced by the recession, are cutting Medicaid, ripping into services provided by nursing homes and assisted-care facilities. The New York Times reported that Nevada’s Republican Gov. Jim Gibbons has proposed ending Medicaid coverage for adult day care, eyeglasses, hearing aids and dentures and limiting the number of diapers provided monthly to incontinent adults to 186, down from the present 300.

My attention turned to these people because of my friend Gary Guthman, who works with Sal Rosselli, the charismatic president of the National Union of Healthcare Workers. Rosselli and his allies formed the union after he was removed from his California leadership post in the Service Employees International Union, the big union headed by the dynamic Andy Stern, a major power in the Democratic Party and national politics.

As explained in a piece in the April 23, 2008, issue of The New Republic by Bradford Plumer, Rosselli believes that Stern, seeking to build SEIU influence, “has made the union too undemocratic, that he has cut secret deals with employers, that he cares more about enlarging the union than serving its existing members. …”

Guthman had urged me to write about the dispute between Rosselli and Stern. My first response was that it was a union beef of interest only to members and management. Guthman persisted, and I finally decided to interview Rosselli. We met in a union office building located amid the crowded apartment houses of the dense Latino neighborhood west of downtown Los Angeles.

How would this fight over which union represents the health care workers affect a patient in a nursing home? I asked. Why should patients “care whether you or Andy Stern win?”

Rosselli, who had helped build the SEIU’s largest health care local in California before breaking with Stern, said that “with the corporatization of health care in the mid-’90s, the priorities of our members changed from the traditional wages and benefits to having a real voice in how care is given. … [They saw] huge cutbacks in staffing. In nursing homes, where a nurse’s aide does the primary care, feeding, bathing, getting people up, on a day shift where it was normal to have six patients and on the p.m. shift 12 patients, they changed the day shift to having 10 or 12, on the night shift 30 patients.” The aides are paid $10 to $12 an hour.

“We see unionized health care workers are the last line of defense against employers making decisions based on profit as opposed to adequate care because unionized health care workers have a union to stand behind them when they blow the whistle on an employer,” Rosselli said.

Stern’s SEIU can’t be trusted with the workers’ welfare, he said. The SEIU has made sweetheart deals with national health care chains, getting their permission to launch organizing campaigns in some hospitals in return for agreeing not to strike and or advocate for patients.

I asked Steve Trossman, the SEIU’s California spokesman, about what Rosselli had said. “If you tell a series of lies enough, people will start to believe,” Trossman said. He said that in facilities organized by the SEIU, staff members and management meet to discuss how to improve quality of care, staffing, supplies and “other issues that have an impact on patient care” and “members are encouraged to report any threat to patients.”

No matter which side wins, the drive to unionize the health care workers deserves our full support. Care workers should be well paid. Enough nurse’s aides should be working the floors. But this is just part of the process of assuring adequate care for their patients. Washington’s help is badly needed.

The number of aged is growing. A high percentage of the elderly and the disabled is likely to wind up in nursing homes or assisted-living facilities or become recipients of home care.

It’s a calamity in the making. As Howard Gleckman wrote in the Kaiser Health News website last October, “we are desperately unprepared for the costly medical and long-term care we are likely to need in old age.” He said that “[t]he annual cost of a nursing home stay is nearly $80,000 and can easily be more. The average cost of a home health aide is nearly $20 an hour. … About 20 per cent are expected to require care for five years or more.”

This is the cruel future that faces our parents, relatives, friends—and us. Such a fate is a powerful argument for President Obama and a recalcitrant Congress to hurry up and act on health reform.

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