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Home / އަލްބަމްތައް / Atlanta, fall 1996 33
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In a room with white walls devoid of pictures and with a couple of large plants, a group of five police officers sit on a couch and two chairs around a coffee table. Two of the officers are using their radios. The others are sitting, semi-relaxed.
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This is a photo of a hallway packed with people. It's shot over the heads and back of ADAPT folks facing away down the hall. Facing toward them, and the camera are Bob Kafka with two Atlanta police officers behind him. All are smiling broadly.
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HEALTH CARE [Headline] Options to Nursing Homes [Subheading] Urgency for Change Driven by Soaring Medicaid Spending by Tom Barry Have you ever known an elderly person who actually looked forward to going into a nursing home?" asks James Ledbetter, director of the Georgia Health Policy Center at Georgia State University. He believes there must be viable alternatives to nursing homes, and predicts that there soon will be. More home health services, foster care homes, assisted living facilities and other alternatives to a nursing home are all attracting new attention. Driving the urgency of the process are soaring Medicaid costs. Medicaid pays the bill for 85% of all nursing home patients in Georgia but provides little funding for less expensive community-based services. “Our payment mechanism in Georgia has caused a very good network of nursing homes to be built," says Ledbetter, "but we must figure out a way to provide incentives for...other levels of service." Ledbetter, whose nonpartisan think tank will soon propose revisions in state Medicaid law, sees a vastly different world for tomorrow's elderly. As managed care has come to hospitals, so too will it be coming to nursing homes, as the state seeks the most appropriate care at the least expense. Skilled-care, high-cost nursing homes should be the facilities of last —- not first — resort, Ledbetter believes, if Medicaid expenditures are to be restrained. He envisions separate facilities for Alzheimer patients, foster homes for the elderly and more personal care homes than exist today. So-called "respite centers” would be available to put up a home care patient temporarily, while relatives take a vacation or just have a night out. A web of home health, homemaker and nutrition services would allow more and more elderly to remain in their own home or with relatives. At the very least, they would be able to stay in their community. [Pulled quote] "Have you ever known an elderly person who actually looked forward to going into a nursing home?” [Boxed text] [Headline] NURSING HOME FACTS: The elderly (65-and older) population will double in eight states -— seven Western states and Georgia -- by year 2020. Georgia's elderly will increase from 695,000 to 1.4 million Over the same period, the number Georgians 85 and over will increase from 245,000 to 735,000. Medicaid pays for 85% of all nursing home care in Georgia, the fourth highest rate in the United States and roughly twice the national average, mainly because of the relatively low eligibility standard. Current standard tor Medicaid long-term care eligibility: $1,410 a month income and assets of $2,000 or less (excluding residence); New federal legislation criminalizes the transfer of assets to quality; Previously people could become eligible for Medicaid three years after signing over assets. Residents 65 and over comprise 12.2% of Medicaid recipients yet receive 27.2% of payments. By contrast, those 0 to 20 years of age make up 58.9% of Medicaid recipients and receive 32.5% of funds. Sixty percent of Georgians have or have had a close relative in a nursing home. Average annual cost of a nursing home in Georgia: $26,000 a year ($30,000 in metro Atlanta area), up from $19,000 a decade ago. Rate is 10th lowest in nation, but 73% of Georgians surveyed say they can't afford it. Approximately 40,000 people live in Georgia's 367 nursing homes. Age breakdown in 1990 Census 89.3% over age 65; 10.4% ages 25 to 64; and 0.3% under 25. Women made up 75% of nursing home population age 65 and over. Forty-tour percent of state residents say they could not care tor a loved one who required 24-hour assistance. Occupancy rate in Georgia nursing homes: 95%. The lifetime risk of going to a nursing home for a woman age 65 is 52%; tor men: 30%. Almost 84% of nursing home residents do not have a spouse, versus 45% tor elderly living at home. Sources: Georgia Nursing Home Association. Georgia Health Policy Center. State Department of Medical Assistance. "My hope is that all people who need long-term care, not just the elderly but also the disabled, will have more options, while encouraging people to be as independent as possible," says Ledbetter, former commissioner of the state Department of Human Resources. In Georgia, as elsewhere, the rite of aging is now frighteningly expensive. When the elderly become unable to care for themselves, or for family members to take care of, the nursing home is usually the only viable option. The decision can be wrenching, both emotionally and financially. With the cost of nursing homes averaging $25,000 to $30,000 a year, the elderly person typically exhausts personal assets in short measure and goes on Medicaid. In Georgia, it's been easy to qualify, with the maximum monthly gross income set at a relatively high level ($1,410 today). Never mind that the elderly person may not have needed a nursing home's round-the-clock care, but only someone to help her — or in much fewer cases, him — get dressed or eat or administer an insulin shot. (Women comprise three-fourths of nursing home residents age 65 and over.) Georgia now has more nursing home beds per capita than any state in the Southeast except Tennessee. Recent audits have shown that 40% of the nursing home residents don't need the high-end care they receive - and that is frequently to put Medicaid monies into less expensive services and pay a capitated rate per patient, in contrast to existing fee-for-service formulas. Fine-tuning the present system remains an option, Ledbetter says, but adds that experts believe managed care is the "most efficient” way to go. Georgia spends roughly one-fourth of its S3 billion Medicaid budget on nursing homes, and demographic changes are increasing pressure on it. A growing haven for retirees, Georgia is the only state east of the Mississippi whose elderly population is expected to double by the year 2020. With geriatric managed care on the rise nationally, the Georgia Health Policy Center is studying how it works in such states as Arizona and Oregon. Ledbetter says whatever system is eventually put in place here, strong government oversight will be needed. (ln 1994-95, 100 of 341 nursing homes in Georgia were deemed unfit to take on additional patients.) The state Department of Medical Assistance, which administers Medicaid, could Even act as the managed care organization itself, as opposed to private organizations competing for the market. Already several firms have shown interest in Georgia. Managed care horror stories abound, Ledbetter acknowledges. "But managed care does just what it's designed to do," he says. "And it would be a mistake to design a system that doesn't improve the quality of care.” Becky Kurtz, state ombudsman for long-term care, expresses concern that managed care firms would “limit the kind of choices people have. We wouldn’t want care to be rationed in a way detrimental to the individual." Kurtz doubts that private companies will want to get into geriatric managed care in the first place, considering the high cost of caring for the aged. "lt's not a population HMOs are excited about.” Anticipating the trend, Georgia's nursing home industry has begun to diversify. “Many of our nursing homes already operate personal care and assisted living facilities," says Fred Watson, executive director of the Georgia Nursing Home Association. "The more progressive homes are doing lab work and hospice and respite care, especially nursing homes in metropolitan areas." Watson believes the tightly regulated nursing industry must be given the flexibility to adapt while protecting patients who truly need advanced care. Under current law, he notes, nursing homes can't discharge patients against their will, even though they may not require such care. "lf we can save money by caring for a patient in a different way, we should be allowed to do that," he says. To envision a nursing home operator positioned for the 21st century, consider Larry Minnix, president and CEO of Wesley Woods Geriatric Center at Emory University. Over the past several years, Wesley Woods has reduced the number of its long-term care beds while building a network of outreach programs to enable the elderly to continue living in a private home. Wesley Woods operates outpatient clinics specializing in Parkinson's disease, memory disorders and psychiatric problems, including depression, the most common undiagnosed condition among the elderly. The geriatric center has forged relationships with various community groups to provide senior citizens with home health care, meals and transportation. The Wesley Woods campus off Clifton Road also offers assisted living quarters, where the elderly needing only minimal aid can live. "Ten years ago, we served 2,000 people annually," says Minnix. "This year we'll serve 17,000 or 18,000, yet we're downsizing our nursing home program." PHOTO: A man in a button down shirt sits at a table with papers in front of him. His hands are loosely clasped in front of his chest. "Managed care does just what it's designed to do, and it would be a mistake to design a system that didn't improve the quality of care. ” ——James Ledbetter, Director, Georgia Health Policy Center [Image] Drawing of three connected two and three storied buildings on a circular drive with several small trees in the center of the circle. Caption reads: Artist's rendering of Wesley Woods 52-acre continuing care retirement community near Newnan. Wesley Woods is building a continuing care retirement community north of Newnan, which will be among the first of its kind in Georgia. When completed, the S40-50 million, 52-acre community will have apartments, cottages, duplexes and assisted living facilities, as well as the more traditional skilled nursing beds. The elderly enter the community while still active and independent and receive specialized services as they age and become less able. Proposed Medicaid changes may ignite a fight in the General Assembly, where the nursing home industry has wielded disproportionate influence. For years, nursing home operators have said that Medicaid reimbursement rates — which average about $20,000 per patient per year — are too low to offset labor and other operating costs. An inkling of what may lie ahead came this past summer, when operators strongly protested state-imposed limits on Medicaid patient bed days and on money paid for management costs. Among other limits, the DMA announced that Medicaid would not pay more than $100,000 toward the salary of a corporate official. (Large corporations own many of the state's nursing homes.) In Fiscal 1995, under the previous funding formula, salary reimbursement exceeded S 100,000 for 22 executive positions in the nursing home industry, with one corporate official getting $615,713 in salary reimbursement. Those protests may be only the beginning of a protracted, fiercely contested battle if other Medicaid limitations are proposed. Minnix has another view. “Some nursing homes are fighting this, but quietly, many of them are just making plans to change. Everybody's looking at the numbers and recognizes we can't continue to pay the price we're currently paying for health care. "Our country spends more on health care than any country in the world and yet when you look at some of the fundamental indices of health, we're not at the top. We're not getting our money's worth. We can improve quality and raise consumer satisfaction while lowering costs." Presumably, corporate salaries might even be included in any lowering of costs.
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The Augusta Chronicle, Thurs. November 7, 1996 Advocacy group members arrested ATLANTA - Police arrested 109 members of an advocacy group for the disabled Wednesday for trespassing at a hotel where a nursing home conference was under way. It was the second time this week that members of Americans with Disabilities for Attendant Programs Today were arrested in Atlanta on criminal trespass charges. About 250 protesters blocked the entrance of the Atlanta Marriott Marquis, where the American Health Care Association, which lobbies for nursing and care homes, was holding a conference. The group has held a series of protests this week in Atlanta, where it is holding its annual convention through Thursday. The group wants the government to redirect federal money to help provide in-home care for people with disabilities instead of forcing them into nursing homes. — Compiled by Jennifer Miller
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news [Headline] Civil Disability [Subheading] Disabled activists protest nursing home stranglehold by Greg Land For nearly an hour they file from the downtown Radisson Hotel, along Harris Street and into the chilly shade of Centennial Park. Man and woman, young and old they come; some walk, some hobble on walking sticks, but the majority roll — in powered wheelchairs, or in simpler models pushed by companions or self-propelled by their occupants. Some 500 disabled activists from throughout the country and as far away as Great Britain rallied Sunday, kicking off the fall convention for ADAPT (Americans Disabled for Attendant Programs Today). Their goal: To end the stranglehold that nursing homes and institutions have on funding for the disabled, and to free up Medicaid and other money so that hundreds of thousands of Americans may live — and work — in homes and offices, just like their able-bodied countrymen. "ln the time it took to get here, 20 people died in nursing homes," booms Bob Kafka from his chair, an interpreter for the deaf signing furiously at his side. Two days before the general election, the assemblage is restive: Kafka informs his listeners that a delegation is conferring with House Speaker Newt Gingrich, attempting to pressure the congressman into fulfilling a 1994 pledge to introduce legislation allowing the disabled to choose between institutional care, and home or community-based services. "We've got word the Newtster’s signed something,” says Kafka. "Well, signing’s one thing —- doing’s another!" A cheer goes up from the crowd, who scheduled their election-week convention in Atlanta to coincide with another convention, and one with an entirely different focus: that of the American Health Care Association, which begins its four-day convocation Wednesday, Nov. 6. ADAPT and other disabled-rights organizations have long assailed the nursing home industry in general, and AHCA in particular, as more interested in profits than in people. ‘The industry is totally resistant to alternative care,” says Mark Johnson, an Atlanta-based ADAPT activist. "Some nursing home operators have gotten into other areas — home—health is one of them — but the industry is realizing that its bread and butter, warehousing people in nursing homes, is breaking down.” As budget cutters sharpen their pencils in Washington and throughout the nation, federal programs are being dismantled, and money is shifting back to states. The problem, says Johnson, is that those funds are still aimed at institutions, and there is no guarantee of any greater availability of home and community-based services. ADAPT cites figures showing the average cost for one year of nursing home care tops $30,000 per person; attendant service averages $8,000. Government numbers show that just 14 percent of Medicaid funding goes to home and community-based care. In preparation for this year's AHCA convention and anticipated acts of civil disobedience, World Congress Center officials enlisted the aid of Johnson and other activists to help train 400 police and security officers in the proper procedures to arrest a disabled person. "AHCA doesn't want to see us," says Johnson with a smile, "but we're going to be there. And they're going to notice us. ADAPT has drafted a resolution it hopes to present to AHCA’s board of directors, for a vote by the entire organization. Among other things, the document seeks AHCA’s pledge to adopt policies promoting the “redirection of 25 percent of all current federal and local spending to self-directed, community-based attendant service," as well as directing that 51 percent of all future spending be similarly targeted. AHCA officers have agreed to meet with ADAPT, but neither side is optimistic of finding satisfactory common ground. "We disagree with their approach," says AHCA spokesman David Kyllo. "We think a comprehensive, long-term care policy needs to be created, including attended care. But we don't think taking from one needy group to give to another is a sound policy." He disputes ADAPT’s charges that as many as 1 illion of the 1.7 million American nursing home residents can be adequately, cared for elsewhere. Studies show that more than 90 percent of nursing home patients are over 65, says Kyllo, and that as baby boomers age, that percentage is going to rise. "Nursing homes are not what they were 20 years ago," Kyllo notes. "A lot of our members support the assisted-living industry. We are the assisted-living industry.” Johnson’s heard it all before. PHOTO BY STAWNIAK: In the midst of a tightly paccked crowd of people, most in wheelchairs and most with small flags, a man (George Roberts) in a wheelchair holds a small child (Stephanie) bundled in a blanket. Behind him stands a woman (Jeanette Roberts). Both are wearing sunglasses and ADAPT caps and the man has a sign taped the side of his chair that reads "DOWN with Nursing Homes." Caption reads: George Roberts and his daughter Stephanie, from Denver, Colo. “They invite us in, talk to us, offer us panels and workshops then do nothing,” he says. "We just want them to introduce this resolution; we know they're gonna vote it down. We want a vote for the record." As of Sunday night, the assembled activists have something else for the record. ADAPT activists gave little credence to a bill Gingrich co-sponsored three days before adjournment this year, painting it as a cynical election-year sop. But Sunday night, Gingrich pledged to create a legislative committee, including ADAPT members, to work directly with his office by Thanksgiving, and to draft legislation to be presented next Ianuaxy aimed at offering a choice of care to disabled Americans." Distributing copies of the two-page document, scrawled in the congressman’s own hand and bearing his signature along with that of ADAPT national organizer Michael Auberger, Johnson is cautiously optimistic. "We've got something," he says. "Now we've got to hold him to it." At any rate, Gingrich has managed to dodge a planned takeover of his campaign headquarters on election eve, and Johnson and his colleagues are plotting other strategies. "This doesn't let Dole and the rest of the Republicans off the hook," he says. "And President Clinton — he's done a lot more for us than Dole or Gingrich, but we're talking to him, too. But we want some action, we want a commitment. Or maybe we'll go on over to the Clinton/Gore headquarters.” Sure enough, several hundred activists spent Monday afternoon occupying the headqaurters of the Democratic presidential candidate, with 86 of them eventually being carted away by police. “We didn't get as much [as from Gingrich] says Johnson. "They did promise to convene a meeting with us within the first quarter of 1997, if Clinton's reelected, and there were no charges against the people who were arrested. Now we're off to AHCA ..." The end
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[Headline] Panel stalls on major fix for Medicaid By Laura Williamson, STAFF WRITER A coalition charged with devising a plan to overhaul Georgia's Medicaid program chose Friday not to recommend any immediate, drastic changes in health care for the poor or nursing home care for the elderly and disabled. After nearly a year of discussion, the Georgia Coalition for Health voted to put more teeth in an existing program that requires patients to get a doctor's permission before getting specialist care or using a hospital emergency room. It's unclear, however, how sharp those teeth will be or how much money the plan could save the state, which faces a potential $400 million budget shortfall in its Medicaid program by 1999. Coalition board members agreed only on the sketchy outlines of a proposal, which they will discuss in further detail at their Nov. 21 meeting. Gov. Zell Miller last year appointed former Department of Human Resources Commissioner James Ledbetter to form the coalition to recommend ways of reforming the state's Medicaid system. The coalition's plan builds on a Medicaid program that allows patients to choose their own doctor but requires them to get that doctor's pen"nissi0n before seeking special care. Medicaid patients in metro Atlanta also currently have the option of joining an HMO, where their choice of a doctor and hospital is limited. The new plan would allow "local communities" — a term the coalition left undefined - to decide what form of managed care they will offer. Communities could offer Medicaid patients an HMO. They could offer a health plan administered by a physician-hospital network. Or they could choose a beefed-up version of the current program that could allow patients to continue to choose their doctors but would scrutinize the amount and type of care those doctors provide. The coalition agreed to ask state Medicaid officials to apply for federal permission to treat more elderly and disabled people in their homes instead of placing them in nursing homes. It will take two years to get that permission, they estimated. After they work out the details of both plans, coalition board members will present their recommendations to the Department of Medical Assistance at a meeting Dec. 4. If DMA accepts the plans, they will be phased in gradually over a two to three year period. The compromise earned the support of physicians and other health care providers as well as patient advocates. They had previously considered three other plans that would have taken effect faster or severely limited a patient's choice of doctor or hospital. Some would also have reduced services to patients or resulted in big cuts to doctors, hospitals and nursing homes. "I think we really need to look at this over time,” said Linda Lowe, a consumer health advocate. “We need to make sure we're really serving the needs of patients." The move into stricter forms of managed care mirrors a move in the private sector, where 20 percent of Georgians are enrolled in managed care plans.
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[Headline] Group urges assisted living for disabled by Laura Williamson, Staff Writer Atlanta Journal Constitution November 4, 1996 Diane Coleman is Not Dead Yet. The Illinois lawyer, in town for a five-day conference on disabilities and human rights, wants to halt a movement to let the chronically disabled take their lives and replace it with efforts to improve their lives. Coleman co-founded Not Dead Yet, a national advocacy group, to fight recent federal appeals court rulings in New York and Washington granting terminally ill and disabled people the right to die by assisted suicide. Such decisions —- which have been appealed to the U.S. Supreme Court — send a message to people with disabilities that their lives are not worth preserving, she said Sunday, speaking in the basement of the Radisson Hotel in downtown Atlanta. "A public policy that says, ‘You people have such miserable lives as a group, we as a society understand why you want to die,’ is a dangerous public policy," she said, addressing the annual conference of the Americans with Disabilities for Attendant Programs Today (ADAPT). Coleman's message — that if you give the disabled assistance living they won’t ask for assistance dying — dovetails with one of ADAPT's major goals. The Denver-based group is fighting for more Medicaid coverage of community-based care for the elderly and disabled that would allow them to stay in their own homes instead of being forced into institutions. At the end of the first day of their five-day conference, about 500 members of ADAPT marched and wheeled their way down International Boulevard and into Centennial Olympic Park to protest inadequate coverage for assisted living programs. In Georgia, as in many other states, Medicaid pays the costs of keeping the elderly and disabled in nursing homes, but often won't pay for less-costly alternatives that would allow them to remain at home with minimal assistance. Legislators approved $10 million in state funds for community-based care in Georgia this year; state Medicaid officials have said they hope to expand that program in the future. Several demonstrators Sunday said that institutionalizing people with disabilities is sometimes what makes them want to take their own lives. Tessa Johnson, 26, of Topeka, Kan., said she opted not to live in a nursing home so that she could hold down a job. Though her muscular dystrophy makes her eligible for nursing home care, her income makes her ineligible for full coverage of the home health care she needs, such as having someone come in to help her dress in the morning. “If I were in a nursing home," she said, "quite frankly, I would probably have absolutely no reason to live." The issue gained attention in Georgia in 1989 when quadriplegic Larry McAfee won a highly publicized court battle allowing him to terminate his own life. McAfee, who had been sent to an Alabama nursing home, was later moved to a personal care home in Augusta, where he chose to continue living and training for a job. 2 photos by Marlene Karas/Staff. Smaller one (top) a close up of a man with a disability wearing a Tyson hat, holding an ADAPT flag in his mouth and a small candle in his right hand. Larger one (below) a woman on a scooter with flags and buttons. She is wearing a Life Worthy of Life shirt, an ADAPT visor and there is a line of people behind her. Rally for care: Elaine Kolb of Connecticut (below) was stabbed in Atlanta l9 years ago. Today, she is back rallying for community care. Manuel Alvarado of Philadelphia (above) joins a vigil.
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CREATIVE LOAFING November 14, 1996 DISABLED ISSUES ADAPT rolls out After five days of conferences, rallies and protests, hundreds of disabled activists headed for home following adjournment of the fall convention of ADAPT (American Disabled for Attendant Programs Today). The Atlanta meeting was particularly productive, say organizers, who secured written commitments from House Speaker Newt Gingrich and President Bill Clinton to press for greater access to home and community-based care for the disabled. The organization, which has been campaigning to increase funding for such programs and steer policy-makers away from nursing home-oriented strategies, even secured a commitment from Georgia Nursing Home Association (GNHA) President Fred Watkins to support a moratorium on new nursing home construction in Georgia. But the concessions did not come easily. More than 400 activists occupied the Clinton-Gore headquarters on election eve, and 86 were arrested — then released — by Atlanta police. The following day, hundreds of demonstrators in wheelchairs blockaded Memorial Drive in front of the GNHA offices, then filled the lobby of the downtown Marriott Marquis, where members of the American Health Care Association (AHCA) were staying during their convention. They sought an audience with AHCA President Paul Wilging, but were unsuccessful; 120 demonstrators were jailed, but a municipal judge released them upon condition they refrain from any more disturbances. "AHCA is becoming less relevant, now that we have legislative measures in the works,” says Atlanta ADAPT member Mark Johnson. "We've definitely got some things to follow up on. We have a committed time-frame for action in Washington, and if things don't get done, we'll escalate again." —- Greg Land
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PHOTO: Shel Trapp, wearing his leather jacket and cap, sitting on a stone bench up against a monument type piece of stone. There is another monument in the background and grass in between. He is looking down at the ground.
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20 — ETC ' NOVEMBER 22, 1996, IN THE NEWS Photo by T. Nash: A young man in a manual wheelchair is next to a police officer by a building wall. A small group of other people are in the background between them. Caption reads: ADAPT acts up at the Marriot Title: Disability actions impact gay community by Rob Nixon Atlanta - Forceful, effective street activism is not dead, it's just being conducted from wheelchairs. And the outcome of recent high-profile protests by disabled people will have a direct affect on many lesbians, gay men and people with AIDS, according to leaders in the disabled community. Close to 500 members of the disability rights activist group ADAPT (American Disabled for Attendant Programs Today) came from around the nation to Atlanta, Nov. 2 — 6, marching on Centennial Olympic Park, shutting down Georgia Democratic Party headquarters and traffic on Memorial Drive and disrupting a national convention site. And they left town with commitments from both Pres. Bill Clinton and Speaker of the House Newt Gingrich (R—Ga.) to introduce and support legislationon home and community-based services. At issue is a system in which the elderly and disabled who depend on Medicaid for their care are forced into nursing homes instead of being allowed to use the coverage to fund services that would allow them to stay at home. ADAPT wants at least an initial 25 percent of public money to go toward providing home care, a proposal strongly challenged by the multi-million-dollar nursing home industry, which stands to lose money if the ADAPT plan is adapted. “Our tax money now goes into putting people into institutions that cost somewhere between $40,000 and $100,000 a year, whereas home and community-based services start as low as $8,000 a year," explains Zan Thomton, community organizer for the federally funded non-profit Disability Action Center based in the Atlanta area and a self-proclaimed “rabble rouser" with ADAPT. As an open lesbian, Thomton also sees the issue as relevant to the gay community. “This was part of Sharon Kowalski's issue, because what her lover, Karen Thompson, was fighting for was to get her into their home and out of the nursing home where [Kowalski's] biological family chose to keep her," Thornton says, refen'ing to the case of the lesbian couple separated in the late 1980s when one of them became severely disabled after an accident. After years of legal battles, Kowalski was finally retumed to Thompson's disability-accessible home. Thomton also says the issue is important for disabled gays who may be forced into nursing homes where they are not wanted and are treated badly. Such problems would be avoidable under the ADAPT plan, says Eleanor Smith, founder and coordinator of Concrete Change, an organization that advocates for disability-accessible housing. “A lot of institutions militate against even heterosexual sex; that's doubly true of gay and lesbian disabled people who want to maintain their erotic and affectional lives," says Smith. “Anti-gay policies and homophobic individuals who have care and control of your immediate life is a scary thing. They can make your life hell, and they do. By receiving vouchers to pay for home care, it's up to you to hire and fire your own help. There are problems with home care, too, but at least you have some choice and control." Smith points out the issue is equally important to people with AIDS who have progressed to the stage where they have functional difficulties and require daily care. “They need and deserve the kind of support that would allow them to be in the place of their choice," Smith says. “Many would choose to use a voucher and stay in their own home." To achieve its goals, ADAPT has functioned over the last 20 years or so similar to ACT UP. The group maintains no official membership or hierarchy, preferring to operate, Smith says, on the basis of “if you do it, you're in it." ADAPT started in Denver with actions that blocked buses to draw attention to the lack of disabled access to public transportation. Such protests eventually led to having access codified in the Americans with Disabilities Act (ADA). “During the fight for ADA passage, gays and lesbians and disabled people hung together and did not allow themselves to be
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Care options urged by Marlene Karas/Staff Atlanta Journal-Constitution November 5, 1996 Demonstrators (from left) Juliet Myer, Claude Holcomb and Cassie James, who want alternatives to Medicaid policies that limit the care options of people with disabilities, sit in Monday at Clinton/Gore campaign headquarters on Spring Street. About 400 members of Americans With Disabilities For Attendant Programs Today, which is meeting in Atlanta this week, blocked access at 1100 Spring St. for several hours before police broke up the demonstration.