Our society at present is composed mostly of aged individuals who needs long term care. Over the last century, the types of illnesses that had affected the American elderly had begun to change. The most common examples in the elderly today include arthritis (46 percent), hypertension (38 percent), hearing impairments and heart conditions (28 percent each), visual and orthopedic impairments (14 percent each), and diabetes (8 percent). About 80 to 85 percent of those over 65 have at least one chronic condition, and a substantial proportion have more than one such condition (Oktay, 1985).
The federal government had passed a number of laws that have directly and indirectly affected the elderly population as it relates to their long-term care. These legislations will be discussed in this paper to demonstrate how relevant it is to the care of the elderly. President Lyndon Baines Johnson signed the Housing Act of 1965 into law in 1965, which was a part of the president’s “Great Society” program (Listokin and Burchell, n. d). The bill created the program that made subsidies available for low- and moderate-income rental units, and it also authorized the subsidy that fostered home ownership by the poor.
The housing needs of inner-city areas were to be met by specially targeted subsidies. The best-known subsidy plan was the Model Cities Program (authorized by the 1966 Demonstration Cities Act), which focused on upgrading the physical (housing, public facilities) as well as the social (education, job training) aspects of inner-city areas. It also recognized the needs of older people for non-institutional congregate housing sites, most of which were age related. There are several programs that provide supportive housing to the frail elderly.
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The Department of Housing and Urban Development (HUD) administers the Section 202 program, under which subsidies are provided for the building and managing of rental housing for the elderly (Clark, 1996). This legislation offered new services for the elderly to remain in their own homes and be cared for. The Medicare and Medicaid programs were signed into law on July 30, 1965. President Lyndon B. Johnson is pictured at the signing ceremony in Independence, Missouri at the Truman Library (Medicare…2006). These are two U. S. government programs that guarantee health insurance for the elderly and the poor, respectively.
They were formally enacted in 1965 as Discuss 10 major pieces of legislation, including names, years of passage… Page #2 amendments (Titles XVIII and XIX, respectively) to the Social Security Act (1935) and went into effect in 1966. Medicare is a federal health insurance program with a uniform eligibility and benefit structure throughout the U. S. The program covers most persons entitled to Social Security benefits, persons under age 65 entitled to disability benefits, and some persons with end-stage renal disease (Clark, 1966).
Medicare is designed to meet the health care needs of acute diseases rather than long-term care. Medicare benefits are provided under two parts: Part A, Hospital Insurance and Part B, Supplementary Medical Insurance. Although most; Medicare recipients receive benefits under fee-for-service arrangements, approximately 10 percent of Medicare beneficiaries are enrolled in managed care plans. Under current law, Medicare home health benefits under either part are targeted at persons recovering from an acute illness.
The beneficiary must be homebound and services must be ordered and reviewed periodically by a physician. Medicaid is a federal-state matching entitlement program providing medical assistance to low-income persons who are aged, blind, disabled, members of families with dependent children, or meet certain other criteria for need. Within federal guidelines, each state designs and administers its own program. There is considerable variation from state to state in persons covered, benefits included, and amounts of payment for services.
Medicaid finances home- and community-based care under three coverage options: (a) home health care, (b) personal care, and (c) home- and community-based waiver services. Medicaid is more responsive to the long-term care of the elderly than Medicare especially for those who are poor and disadvantaged. President Lyndon B. Johnson signed the Older Americans Act into law on July 14, 1965. In addition to creating the Administration on Aging, it authorized grants to States for community planning and services programs, as well as for research, demonstration and training projects in the field of aging.
Later amendments to the Act added grants to Area Agencies on Aging for local needs identification, planning, and funding of services, including but not limited to nutrition programs in the community as well as for those who are homebound; programs which serve Native American elders; services targeted at low-income minority elders; health promotion and disease prevention Discuss 10 major pieces of legislation, including names, years of passage… Page #3 ctivities; in-home services for frail elders, and those services which protect the rights of older persons such as the long term care ombudsman program (http://www. vec. virginia. gov). This policy was an answer to many of the domestic difficulties of the elderly, it gave them supportive services that has been incorporated in the long-term care program of the elderly. The Age Discrimination in Employment Act of 1967 (ADEA) protects individuals who are 40 years of age or older from employment discrimination based on age. The ADEA's protections apply to both employees and job applicants.
Under the ADEA, it is unlawful to discriminate against a person because of his/her age with respect to any term, condition, or privilege of employment, including hiring, firing, promotion, layoff, compensation, benefits, job assignments, and training (The U. S. Equal Employment Opportunity Commission). The act was signed into law by President Lyndon Johnson on December 15, 1967. Through this policy, the employed elderly were protected from unjust employment practices, in relation to long-term care; it gave the elderly earning power and thus could pay for health insurance that would pay for their health care needs.
The Americans with Disabilities Act (ADA) was signed into law by President Bush on July 26, 1990. The central purpose of this Act is to extend to individuals with disabilities civil rights protections similar to those provided to individuals on the basis of race, sex, national origin, and religion. Based on the concepts of the Rehabilitation Act of 1973, the ADA guarantees equal opportunity for individuals with disabilities in employment, public accommodation, transportation, state and local government services, and telecommunications.
The ADA is the most significant federal law ensuring the full civil rights of all individuals with disabilities (Wodatch, 1990). This policy gave person’s with disability the opportunity to become functioning individuals in society, however, The policy is really not that relevant to long–term care, wherein people with mild or moderate disabilities are the only ones who can benefit from this policy since those who need institutional care and long-term care cannot become fully functioning members of society.
Signed into law by President Nixon in 1972, the Supplemental Security Income (SSI) program replaced a patchwork of state programs for the aged, blind, and disabled. SSI improves the Discuss 10 major pieces of legislation, including names, years of passage… Page #4 quality of life for persons who are elderly or have a disability by providing financial support, incentives to work, and access to medical care (through Medicaid; enrollment in SSI generally brings with it eligibility for Medicaid).
These elements of the program have helped make it possible for poor people who are elderly or have disabilities to gain freedom from destitution and institutional care (Sweeney and Fremstad, 2005). The policy makes the costs of long-term care more bearable for the elderly and the poor, it however increases the administration of caring and nursing in the home rather than in institutions. On September 26, 1973, President Nixon signed the Rehabilitation Act of 1973 into law. This is a civil rights law to prohibit discrimination on the basis of disability in programs and activities, public and private that receives federal financial assistance.
Section 504 states that "no qualified individual with a disability in the United States shall be excluded from, denied the benefits of, or be subjected to discrimination under" any program or activity that either receives Federal financial assistance or is conducted by any Executive agency or the United States Postal Service (Pfeiffer, 2002). This policy was the first to address the need and rights of persons with disabilities but was consequently met with opposition from the general public as it meant giving equal opportunity to persons with disability.
The policy increased the demand for rehabilitative services but at that time was limited. Title XX of the Social Security Amendments of 1974 authorized grants to states for social services. These programs included protective services, homemaker services, transportation services, adult day care services, training for employment, information and referral, nutrition assistance, and health support (Oktay, 1985). The funds were distributed to the states according to the size of the population. States were to define the eligible population and design a package of services (many of which were mandated).
While Title XX funds were not earmarked for the elderly, there are a number of services, which are targeted primarily to elderly populations, among them, homemaker services. In FY 1982, the Title XX funds were replaced by the Social Services block grant which allowed the states to choose the programs and services that they want to spend on to alleviate the Discuss 10 major pieces of legislation, including names, years of passage… Page #5 conditions of the needy. However, social services for the elderly who can take care of themselves maybe provided.
Most states provide homemaker and chore services as well as adult protective and emergency services for their elderly citizens, in order to prevent or reduce inappropriate institutional care (Clark, 1996). On July 1, 1988, President Bush signed into law H. R. 2470, the Medicare Catastrophic Coverage Act of 1988 (MCCA). This law provided the most significant expansion of the Medicare program since its inception. It also contained numerous technical amendments to the Medicare and Medicaid programs, as well as three new Medicaid provisions.
However, the following year, the President signed into law Public Law 101-234 that repealed the major expansions of the Medicare program enacted the previous year (Centers for Medicare and Medicaid Services). The act expanded Medicare coverage of inpatient hospital care and will also provide payment for outpatient prescription drugs and home i. v. therapy. For the prescription drug benefit, deductible and coinsurance payments will be phased in, and Medicare will establish payment limits. A per diem fee schedule will be established to pay for the supplies and services used in home i. . therapy. Providers of home therapy must have qualifications specified by the act (Grealy, 1989).
The policy increased the demand for training of health-care providers that are home-based. It gave the elderly long-term care in their own homes rather than in hospitals or institutional facilities. It also paved the way for the employment boom of caregivers in the country. On July 26, 1990, President George H. W. Bush signed into law the Americans with Disabilities Act of 1990 (ADA) -- the world's first comprehensive civil rights law for people with disabilities.
The Act prohibits discrimination against people with disabilities in employment, in public services (Title II), in public accommodations and in telecommunications (U. S. Equal Employment Opportunity Commission). The policy enforced guidelines that called for states to review the funding they gave to long-term care. It also emphasized the desegregation of the mentally disabled from the rest of society. The act has brought a decrease of admittance to nursing and institutional facilities, and increased the demand for home-based healthcare services.
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