History
Long-Term Care – History
An economic crisis gripping the country has led to a precipitous decline in Oregon’s revenues, rapidly turning a comfortable surplus into an alarming shortfall. Faced with a series of hard choices, the Governor and Legislature turn to the Human Services budget and the Medicaid program with the goal of cutting costs while still striving to protect the most vulnerable Oregonians.
Sound familiar? The governor was Vic Atiyeh and the years were 1979-81. And one choice that emerged from that budget crisis — Chapter 410 of the laws of Oregon — still stands as a signal achievement of creative governing, an example of how economic necessity can drive enlightened policy.
Passage of Oregon Revised Statute 410, combined with Oregon’s then unprecedented application for a waiver of the federal Medicaid rules, allowed the state to conserve resources by spending Medicaid dollars on less costly in-home and community-based long-term care rather than just nursing homes. But it did more than save a lot of money. It amounted to an emancipation proclamation for elderly and disabled Oregonians. The language and intent of that law is worth revisiting today:
“The state… shall assure that older citizens and citizens with disabilities retain the right of free choice in planning and managing their lives
- by increasing the number of options in life styles available to [them],
- by aiding [them] to help themselves,
- by strengthening the natural support system of family, friends and neighbors to further self-care and independent living,
- by assuring [they] are able to make informed choices regarding the delivery of in-home care services…; and
- by encouraging all programs that seek to maximize self-care and independent living within the mainstream of life.”
Spurred as much by prudence as humanity, Oregon’s model approach to long-term care has BOTH saved hundreds of millions of dollars AND preserved and enhanced lives.
State after state has tried to duplicate what Oregon has accomplished for both clients and workers. Oregon is held up as a pioneer and the model for long-term care.
However, decades of neglect and disinvestment have weakened this system. And while states still look to Oregon as a national model and leader, they’re also looking to learn from its mistakes and ensure proper investment.