‘Induced dependency’

But Kane argues that many people are sick in nursing homes precisely because they’ve been rendered incapable of going back to the community — by the very nature of nursing-home life.

“It’s not due to malevolent efforts by the nursing home people,” Kane said. “Many seniors just don’t function as well in nursing homes because the nursing homes have induced dependency — seniors don’t bathe themselves or take their own medications ... and therefore many become de-conditioned, demoralized and depressed.”

While they don’t doubt that nursing-home residents are ill, home-care aides point out that many of the frail clients they serve manage to stay home with just 10 or 12 hours of home-care assistance per week.

“Most of my clients right now, they’ve been told at one time or another that they needed to live in a nursing home,” aide Cheryl Jones said. Allowing them to stay home, with fairly minimal assistance, has prolonged their lives, she added — and saved government dollars.

Advocates blame the long-established and well-funded nursing-home lobby for the state’s sluggish response to serving frail seniors at home. “In Virginia, more money has to be coughed up” for home care Medicaid reimbursements, Kane said. “That’s the only way to fix it.”

But the issue is complex — for the public and politicians alike. “You’re lucky to find two people in any state legislature who understand long-term care,” Kane said. “Most politicians get most of their information from the nursing-home lobby.”