Americans want to be in the company of their loved ones in their final years. When a loved one is sick and in need of long term care in the last years of life, they almost always prefer to be at home and in the company of family. This is sometimes an option for family members, but sometimes it isn't possible because of financial considerations. Medicare covers some aspects of in-home health care through private duty nursing, registered social workers and personal health care attendants, but it generally does not pay for family members to stay home and care for their loved ones.

This is a situation which needs to be resolved as part of comprehensive medical care legislation restructuring. It is time for us to move to a single payer health care system to address the needs of some 47 million Americans without health insurance. It is time for us to move toward preventative medical care rather than urgent need expensive medical care for undiagnosed illness and it is time for us to look at in home health care options for family members who wish to remain home and their loved ones who wish to care for them.

This is an option which can be structured as a win-win situation. If we do this right, family members can stay home to care for their loved ones without the threat of total loss of income. The burden on nursing home and long term care facilities can be reduced, thus passing on the savings in cost to the taxpayers, who are often times supplementing the costs of long term medical care in institutional settings through their tax dollars. Nursing home and institutional long term care is the most expensive and least desirable option for most individuals. All that we need to do is get smart about we pay for health care delivery in this country and think about ways to meet peoples needs where they are, rather than to meet the needs of Health Maintenance Organizations and their investors.

Family members who make the sacrifice to take care of loved ones are already doing most of the work. They are often times doing the cooking, the cleaning, the laundry, as well as providing transportation and much needed emotional support to the infirmed. If they can afford to make this sacrifice for their loved ones they deserve our respect and admiration. If they cannot afford to take care of them then they deserve our support.

In order to get the ball rolling an in home evaluation would be necessary from a nurse or social worker and certified by a doctor or attending physician. After an individual has been certified, monthly in-home reviews and quarterly clinical reviews would add safeguards to assure quality of care. When certification is supplemented by in home attendant care providers and private nursing attendants as needed, quality of care can be assured in most cases. It makes sense for Medicaid to pursue this cost saving option. Most family members prefer to stay at home in their final years of life and they prefer to be cared for by family members. Let's give them this common sense option.