The Community Choice Act is a proposed United States federal legislative initiative. The act has been advanced by people with disabilities and their allies, as well as Senate and House co-sponsors, to ensure that people eligible for care in a nursing home are also eligible to receive attendant care in their private homes, under a movement known as community-assisted living, or independent living, in which people with disabilities or the elderly live in their own homes with community "supports".
One can find a separate legislative effort in the healthcare reform bill of 2009 in the House commonly confused with the Community Choice Act. The CLASS Act would allow more people with disabilities to receive social security benefits if they paid into it for five years, shorter than a person without disabilities. Critics charge that the legislation does not address the need for personal care services, services which are often needed by people with disabilities. The lack of such services in the community forces many people with disabilities into nursing homes.
| Congress | Short title | Bill number(s) | Date introduced | Sponsor(s) | # of cosponsors | Latest status |
|---|---|---|---|---|---|---|
| 110th Congress | Community Choice Act of 2007 | H.R. 1621 | March 21, 2007 | Danny K. Davis (D-IL) | 125 | Died in committee |
| S. 799 | March 7, 2007 | Tom Harkin (D-IA) | 21 | Died in committee | ||
| 111th Congress | Community Choice Act of 2009 | H.R. 1670 | March 23, 2009 | Danny K. Davis (D-IL) | 131 | Died in committee |
| S. 683 | March 24, 2009 | Tom Harkin (D-IA) | 26 | Died in committee |
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In the United States, Medicaid is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.
A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. The nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the healthcare program of the VA through a nationalized healthcare service in the United States, providing healthcare and healthcare-adjacent services to Veterans through the administration and operation of 146 VA Medical Centers (VAMC) with integrated outpatient clinics, 772 Community Based Outpatient Clinics (CBOC), and 134 VA Community Living Centers Programs. It is the largest division in the Department, and second largest in the entire federal government, employing over 350,000 employees. All VA hospitals, clinics and medical centers are owned by and operated by the Department of Veterans Affairs as opposed to private companies, and all of the staff employed in VA hospitals are government employees. Because of this, Veterans that qualify for VHA healthcare do not pay premiums or deductibles for their healthcare but may have to make copayments depending on what procedure they are having. VHA is distinct from the U.S. Department of Defense Military Health System of which it is not a part.
An assisted living residence or assisted living facility (ALF) is a housing facility for people with disabilities or for adults who cannot or who choose not to live independently. The term is popular in the United States, but the setting is similar to a retirement home, in the sense that facilities provide a group living environment and typically cater to an older adult population. There is also Caribbean assisted living, which offers a similar service in a resort-like environment.
Independent living (IL), as seen by its advocates, is a philosophy, a way of looking at society and disability, and a worldwide movement of disabled people working for equal opportunities, self-determination, and self-respect. In the context of eldercare, independent living is seen as a step in the continuum of care, with assisted living being the next step.
Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders, mental health, HIV/AIDS, chronic illness, diverse disabilities or other serious challenges to stable housing.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home.
Supported living or supportive living refers to a range of services and community living arrangements (CLAs) designed with individuals with disabilities and their families to support disabled citizens to attain or retain their independence or interdependence in their local communities. Supported living is recorded in the history of the NASDDDS, celebrating its 50th Anniversary. Community Supported Living Arrangements (CSLA) was a landmark federal multi-state demonstration to illustrate the federal role in community living in the US. Supported living is considered a core service or program of community living programs funded through federal-state-local partnerships.
A group home, congregate living facility, or care home is a residence model of medical care for those with complex health needs. Traditionally, the model has been used for children or young people who cannot live with their families or afford their own homes, people with chronic disabilities who may be adults or seniors, or people with dementia and related aged illnesses. Typically, there are no more than six residents, and there is at least one trained caregiver there 24 hours a day. In some early "model programs", a house manager, night manager, weekend activity coordinator, and four part-time skill teachers were reported. Originally, the term group home referred to homes of 8 to 16 individuals, which was a state-mandated size during deinstitutionalization. Residential nursing facilities, also included in this article, may be as large in 2015 as 100 individuals, which is no longer the case in fields such as intellectual and developmental disabilities. Depending on the severity of the condition requiring one to need to live in a group home, some clients are able to attend day programs and most clients are able to live normal lifestyles.
Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, nutrition, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.
In England, social care is defined as the provision of social work, personal care, protection or social support services to children or adults in need or at risk, or adults with needs arising from illness, disability, old age or poverty. The main legal definitions flow from the National Health Service and Community Care Act 1990, with other provisions covering disability and responsibilities to informal carers. That provision may have one or more of the following aims: to protect people who use care services from abuse or neglect, to prevent deterioration of or promote physical or mental health, to promote independence and social inclusion, to improve opportunities and life chances, to strengthen families and to protect human rights in relation to people's social needs.
The Pennsylvania Department of Aging is a cabinet-level agency charged with providing aid to Pennsylvania's approximately three million individuals age 60 and older. Although the bureau operates some services directly, such as the Pharmaceutical Contact for the Elderly (PACE) prescription drug program, it generally serves as a clearinghouse of funding and information for county-level Area Agencies on Aging. The department was formed under the governorship of Milton Shapp.
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), formerly known as Intermediate Care Facilities for Mental Retardation (ICF/MR), is an American Medicaid-funded institutional long-term support and service (LTSS) for people with intellectual disabilities or related conditions. Section 1905(d) of the Social Security Act enacted benefits and made funding available for "institutions" for individuals with intellectual or related conditions. According to federal law 42 CFR § 440.150 the purpose of ICD/IIDs is to "furnish health or rehabilitative services to persons with Intellectual Disability or persons with related conditions."
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
Professor Lord Darzi's review of the NHS in 2008 introduced the idea of personal health budgets (PHBs) in the English National Health Service. Since October 2014 people eligible for NHS Continuing Healthcare were given the legal right to have a personal health budget. NHS England’s Five Year Forward View called for a ‘major expansion’ of the scheme. NHS Choices describes personal health budgets as a way "to give people with long-term conditions and disabilities greater choice and control over the healthcare and support they receive."
Aged care in Australia, is the provision of services to meet the unique needs of older people in Australia. It includes both residential aged care as well as services provided in the home such as personal care, domestic assistance, home nursing, nutrition and meal preparation, respite services, continence management, mobility & dexterity assistance, transport, social support and the provision of equipment and aids.
Audrey Aanes is sometimes referred to as Mother of the Independent Living Movement in Alaska. Aanes received both a Bachelors and Master's in Special Education from the University of Northern Colorado following spending two years in the Peace Corps. Her other career focus was in the physical disability field. She founded the community, Access Alaska, which allows people with physical disabilities to live independently.
Stacey Park Milbern was a Korean-American disability rights activist. She helped create the disability justice movement and advocated for fair treatment of disabled people.