Making a Difference One Person at a Time:
Seizing Control of Our Destiny

America is the greatest country in the world because it is so generous in bestowing freedom upon its citizens. Americans can go where they want, do what they want, and say what they want without fear of reprisals. We are free to worship as we please and we have a free press as the guardian of our liberties.

Americans have the right to assemble peacefully, to march or demonstrate, and to express their views. We have a say in who represents us in government, and each citizen has the right to vote. We have the right to petition government and ask that policies important to us be implemented or oppose those we think are inconsistent with our values.

These rights and freedoms were won at great cost. This fact is driven home whenever we are involved in war. Thousands of Americans have made the supreme sacrifice to allow us, and future generations, to enjoy precious freedoms. This being said, our freedoms come with correlative responsibilities.

We have a responsibility as citizens to participate in the governmental process. We should identify and support those who run for public office who best reflect our views. We have the duty to vote because - as was evident in the 2000 and 2004 Presidential elections - every vote counts. We have a duty to fight for those causes or interests that we think are important.

The National Association for Home Care & Hospice (NAHC) has scheduled its National Policy Conference (and March on Washington) in the spring of each year since NAHC was first formed in 1982. This meeting allows those who are advocates for home care and hospice, and the seniors and disabled citizens they serve, to come together. The organizers of NAHC knew what the Founding Fathers of the Republic meant when they wrote: E Pluribus Unum - "Out of many there is one," as our national motto. It means, "In unity there is strength."

Like the early American patriots who left their farms and jobs to petition government, home care and hospice executives have each year taken time away from their work at their agencies to fight together for the best interest of the patients they serve and the caregivers they employ.

The year 2006 is shaping up as a very challenging one, it will be a time of both danger and opportunity. It will be a year of opportunity because:

The year 2006 is an election year. Members of Congress are always on their best behavior in the months that lead up to an election. All 435 seats in the House and a third of the 100 seats in the Senate are up for election. At stake is control of Congress. Republicans, who control both chambers, are trying to maintain their positions knowing that the party winning the Presidential election historically loses Congressional seats two years later in the mid-term elections. Democrats are vying to get back into power.

The December 2005 White House Conference on Aging will set the stage, providing impetus to home care and hospice legislation. Delegates from all over the U.S. will set their agenda which, given their clout in the electorate, will find great acceptance.

Legislation to expand Federal coverage for long term care will be high on the national agenda. Such legislation is being driven by demographics, especially the fact that the 77 million Baby Boom Generation is only 5 years from beginning retirement. A major push is coming from technology which makes it possible to do at home (and with the same effectiveness) almost anything which is done is a hospital, save major surgery. Increased public awareness and public acceptance of home care is an accelerant. The cost effectiveness of home care and hospice as opposed to institutional options is also a major driver toward expanding home care.

Home care and hospice will be a hot political issue. In 2001, the U.S. Supreme Court said in the Olmstead case that individuals must be afforded health care by the states in the least restrictive environment - which means at home. In 2004, the National Governors Associations proclaimed long term care as the greatest problem facing America and pointed to home care and hospice as the best answer to the problem. In addition to the Governors, the Baby Boomers, the elderly and the disability community all list long term care as the top issue to be addressed in America.

Home care has proved its value in responding to national emergencies whether acts of terrorism such as 9/11 or natural disasters such as Hurricane Katrina and Rita. Emergency preparedness legislation will be on the agenda and home care should be a vital part of it.

The political clout of home care and hospice is growing. Some 2 million people are employed in home care and hospice jobs. The Bureau of Labor Statistics list home care aides and personal care assistants as two of the top ten professions that will be in need over the next ten years. Almost $100 billion is paid for home care and hospice services in the U.S. every year and another $300 billion in unpaid home care is provided. Today, there are many times more people who are cared for in hospice and home care in any given year than are cared for in U.S. hospitals or nursing homes. The National Association for Home Care & Hospice, today is more united than ever, representing the lion's share of the nation's 10,000 Medicare participating hospices and home
care agencies as well as non-Medicare participating agencies through its Private Duty Homecare Association of America. Support for home care is both broad and deep in the Congress. Given their average age, most members of Congress will have experienced the illness, disability or death of their parents. Their familiarity with home care and hospice thus gained has helped make most members of Congress passionate advocates of the services. Support runs in both political parties, among conservatives as well as liberals.

The year 2006 will present some significant dangers because of the following factors:

• The War in Iraq will continue. The war costs upwards of $1 billion a day to support the over 100,000 troops that the U.S. has there. The numbers are higher with Afghanistan added to the equation. The war will continue to divert money and resources such as gasoline away from domestic programs.
  
  
• Budget deficits will continue to escalate. The war is being funded in large part by deficit spending that is money borrowed from others secured by a promissory note from Uncle Sam. The Chinese and the Japanese are the primary lenders to the U.S. The total deficit has been accumulating as approximately $400 billion a year and now totals about $4 trillion. Interest on the Federal debt runs about $191 billion and is the third largest (and fastest growing) part of the U.S. Budget. The accumulated debts will be paid by the children and grandchildren of Americans living today.
  
  
• Because of the War in Iraq and Afghanistan and the one against terrorism, the defense budget will continue to escalate. This is the largest portion of the U.S. Budget today and expenditures are slated to increase, diverting resources that could be spent to solve domestic problems.
  
  
• Expenditures for housing and roads, infrastructure and schools (which has been the smallest and declining portion of the budget) will increase. Part of the increase will be a response to Hurricane Katrina and Rita. Similar tropical storms are predicted for the next six years.
  
  
• Expenditures for the remaining and second largest portion of the budget, entitlements, will remain under attack. If Defense spending, interest on the Federal debt and spending for all domestic programs are growing, the remaining category which includes Social Security, Medicare and Medicaid will increasingly be under the paring knife. There is simply no place else to go for money save to raise taxes which the Administration has vehemently opposed.

What this all means is that something has to give. There will be pressure from the Baby Boom generation, seniors, the disability community and others to expand the scope of Federal and State home care and hospice programs (and to cover long term care) and simultaneously pressure to cut some existing entitlement programs. Which programs will be cut or privatized (the effect is the same) remains to be seen.

How this will all be resolved is in large part within the power of the members of the home care and hospice community.

Those who sit back passively with the victim's mentality will indeed become victims. Those who move forward together aggressively and seize control of their own destiny will win the day. Mahatma Gandhi put it well when he said, "We must be the change we wish to see in the world."

In 2006, the 25th anniversary of its founding, the members of the National Association for Home Care & Hospice are called to unite in their common interest, in the interest of the patient they serve, the people they employ and in the interest of the nation at large.

Home care and hospice interest have come far in 25 years thanks to the industry's banding together under the banner of NAHC.
In 1982, hospice did not exist as an industry in the United States and the dollars spent on home care within the national health care budget were too small to merit more than an asterisk. Today public and private spending on home care and hospice is the fastest growing part of the nation's health care expenditures. Public knowledge and acceptance of home care and hospice has increase from about 20 percent to more than 80 percent of the U.S. public.

The future stands ready to be determined. Home care and hospice providers, consumers, interested citizens representatives of major U.S. Corporations and the U.S. Government are invited to be part of the solution. Like their forefathers from 1776, the current generation has a rendezvous with destiny, to fight the last great civil rights battle: to confirm once and for all that all U.S. citizens have a right, especially when they are ill, disabled or dying, to be cared for in their own homes, the setting that they most prefer.

The place is Washington, DC. The Battle will be joined on March 26-29, 2006. History and fortune favors the brave, the believers and the courageous.

Val J. Halamandaris, JD President