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Taking Care of Our Old Folks: Re-installing Self-Governance into our Lives

January 15, 2003

I recently had the opportunity to attend some lobbyists-sponsored functions in Nashville during the swearing-in and opening sessions of the new Tennessee state legislature. (See my previous articles in the rightturns.com archives for why I was at the Tennessee legislature swearing-in ceremonies). These are food and drink parties where the sponsoring group can introduce their "legislative liaisons" and explain their positions on the issues around which their group is organized. These events are surrealistic to the conservative way of thinking in some sense. (Most of us think "Yechh" when lobbyists are brought into the political discussion. The fact is, however, that everyone one of us in this country is connected to some group that lobbies in the state and/or federal legislatives.)

The surrealism to my conservative mind is because most lobbyist groups are focused on getting their "fair share" of appropriated money for their "constituents"; not on exploring different ways to solve their issues. When you question them on why more money is the solution when more money in the past did not solve the "problems", you get no answer. When you suggest "other" solutions, you get cool looks. When you say the comptroller reports notes that most state program budgets (including the ones on which the lobbyists are focused) grew much faster than the growth in number of program recipients/enrollees, you get the "that is still not enough funding" response.

For example, the legislative agenda for the Tennessee chapter of the American Association of Retired People (AARP) includes the improvement of nursing home care: tighter state regulations to reduce the growing number of abuse problems, more state oversight, more state inspections, and incentives for the nursing home operators to run better facilities.

The second part of the AARP agenda states that most people don't wish to end up in a nursing home so home care needs to be more readily available across the state, i.e., more funding for home care. Upon closer questioning, home care is defined as a "professional home care specialist" coming into the home of the elderly and caring for them.

During the drive home, I began to think through all that I had heard. My first thoughts were that if home care is preferred over nursing home care then shift monies from one to the other. Of course, the nursing home lobbyists would attack that idea.

My next thoughts were that more aggressive pursuit of abuse cases and tougher sentencing in such cases would help solve the abuse problems. Then it occurred to me that I was falling for the liberal trap of trying to solve symptoms not problems.

The identification of the real problem came from one of my conversations at the AARP reception. Several AARP people told me that 65% of nursing home patients have no family visitors.

That stunned me.

I asked what does the AARP research reveal as to why they don't have any visitors, i.e., where are the families of these old folks? No one knew the answer to that. Apparently no research has been done.

Well, without research I can confidently predict one thing. No matter how tightly regulated, no matter how tough the sentencing laws, no matter how many inspections nursing homes are subject to, no matter how many incentives you provide nursing home operators to improve their facilities, nursing homes will never provide the level of care that the family can provide. We see the same thing in schools; per student spending constantly rises yet with little improvements in results. Real improvements only come about when the parents become connected to their children's educations. I believe the same holds for elderly care. (I define elderly care as the time when mom or dad can no longer live alone without constant assistance.)

So what are some conservative ideas of how to shift elderly care responsibility from the state back to the families? And why is that important?

Let me answer the latter question first. Charles Murray's insights in his classic book, In Pursuit of Happiness … and Good Government, provide the clues. He identifies one of the most insidious results of government "solutions" to societal issues is the taking away of intrinsic rewards (accomplishment, helping the less fortunate, making a difference, experiencing the full cycle of life, etc.) from the citizens. We, the citizens, therefore suffer deep emotional dissatisfaction that only intrinsic rewards can eliminate, not new cars, surround sound systems, bigger homes, fancier vacations, or second homes.

Back to the first question: what are some conservative ideas of how to shift elderly care responsibility from the state back to the families? Let me throw some out.
1. Tennessee spends $3000-$5000 per month on nursing home care. Why not offer that to families tax-free so an adult can stay at home and take care of mom or dad in their last year(s)?
2. Allow sales tax free purchases and/or property tax rebates for stay-at-home care.
3. Stop the practice of allowing future heirs to siphon off money from mom and dad's net worth so they can "better qualify" for state financed nursing home care.
4. If you have other ideas send them to me.

I do not pretend that at-home elderly care is easy. It is not. I do not pretend that at-home elderly care is popular. It is stressful on families emotionally and financially. It disrupts vacation plans and other family activities. It is, however, the overwhelming preference of elderly people. Just ask them.

And it is the right thing to do.

Our family cat recently died after a long (16.5 years) and healthy life. The veterinarian soothed our sadness by congratulating us for keeping the little cat all the way through her "nursing home" (his words) years. He said that many pet owners look for ways of getting rid of aging pets before they become too old and troublesome. Sadly, I wonder if that is what is we are doing to our parents.


Sam T. Harper graduated cum laude from Vanderbilt University.  Following a tour in the US Navy and a stint as Operations Manager at Roadway Express, he earned his MBA from Stanford University Graduate School of Business.  He was a contributor to “In Search of Excellence,” the best selling business book of all time.  Sam was also Manager, Economic Planning & Analysis at Sohio Petroleum, Partner and Chief Financial Officer at investment-banking firm Bridgemere Capital, and Chief Operating Officer of the Institute for Contemporary Studies, a San Francisco Bay Area-based think tank and international publishing firm that specializes in self-governing and entrepreneurial public policy.  Sam was a chairman of the San Francisco Republican party and the GOP co-host of California Political Review on KALW-FM in San Francisco.  Sam is currently the co-owner of the Tennessee based Institute for Local Effectiveness Training, LLC – a management consulting, training, and coaching firm.