Programs giving the disabled the option to leave large, structured nursing homes in favor of living in their own homes, with aides provided, or in settings such as group homes, may well be the early ripples of a wave of the future. It's probably safe to assume most people would prefer to stay out of nursing homes if at all possible. If so, the realities of budgets and demographics may play out to the advantage of most of us.
Governments at every level in the United States are facing severe budget problems that extend for years into the future. However the political class eventually deals with those problems, reform of Medicare, Medicaid, and the larger healthcare system will be part of the approach. Ways to economize while still providing people with the basic help they need will be developed. Demographics will push that trend, as well. The American population is aging, and will demand care suited, as much as possible, to the lifestyle those people have established for themselves.
Without doing any real calculations, it's likely that a person staying in the home they own with aides provided by government program is less costly to the government than paying to support that person in a traditional nursing home, because that involves paying for the overhead of the facility, the enforcement of regulations, a large staff, etc. Providing housing for individuals may also actually save government money, though that is a closer call, dependent on various factors.
The emergence of telemedicine will strengthen the trend allowing people to live on their own terms. Doctors will be able to monitor the health of their patients over the Internet, allowing more people to continue living in their own homes. To the extent that working to maximize the independence of the disabled creates programs and approaches that can serve as models for helping the elderly a few years hence, the philosophy developed now can lead to a less centralized future, one focused on the dignity of each individual.
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