05/18/2003

Associated Press

ST. HELENS, Ore. - On the wall of Clifford and Mary Carpenter's apartment in St. Helens hangs a faded, black-and-white photograph taken in Oklahoma in 1925, showing Clifford playfully trying to pull Mary onto his lap.

Two years later, they married in the county courthouse in Buffalo, Okla., and moved west to Idaho after the stock market crash in 1929. They raised five children during the depression.

Now the teenage sweethearts, who celebrated their 75th wedding anniversary in October, may have to live apart because Mary, who is 93, has lost her long-term care benefits under Medicaid and must leave the room they share in a residential care facility.

Clifford, who is 96 and has greater medical needs, is still covered under Medicaid and can remain in the room. Their case is under appeal in state and federal court.

The attempted eviction of Mary shows the deep cuts to senior's assisted living benefits as Oregon and 28 other states try to balance budgets by shedding Medicaid recipients. State officials say they have no money and no choice.

Assisted living is among health care services most severely cut, because it was never required under the 1965 federal Medicaid Act, the country's largest provider of long-term care for seniors.

The combined state and federal program pays about 42 percent of the $117 billion or so spent annually on long-term care for seniors.

Beginning in 1981, all states but Arizona expanded Medicaid to cover various types of assisted living, the cozy, but less-medically equipped alternative to nursing homes, which tend to operate more like hospitals.

The exodus from nursing homes followed a trend of aversion for institutionalization, led by younger people with disabilities. It came as life spans stretched longer and seniors preferred to remain active and independent longer.

Assisted living is cheaper than nursing home care. It costs about half as much as the $3,000 or so monthly outlay for a nursing home bed. For this reason, states prefer to place people who would qualify for long-term care under Medicaid in assisted living, said Marylee Fay, an Oregon Department of Human Services official responsible for senior care.

But, encouraged by a strong economy in the 1990s, states greatly expanded the program to provide for seniors who are too healthy to qualify for 24-hour nursing care under Medicaid, yet need some help cooking, cleaning or bathing.

By this year, about 800,000 Americans lived in 33,000 assisted living homes around the country.

Oregon led the pack. By 2000, it had the highest percentage of any state of Medicaid recipients in assisted living and home-based care, according to a 2000 study by the University of California at San Francisco. Oregon has been the only state in the nation with a declining nursing home population in recent years.

"Oregon led the way for many years in a very progressive approach to care," said Jenny Kaufmann, a Portland attorney who handles Medicare cases. People are "living healthier and they're living longer. To be stuck in nursing homes for years and years is just not a viable alternative."

When the economy soured in 2001, Oregon officials started backpedaling frantically, critics say recklessly, to salvage the state budget. In February and April, Oregon cut 4,729 out of 28,900 seniors receiving long-term care.

And the cuts go on.

Among those told they will lose coverage in Oregon: a man in Seaside with two prosthetic hands who cannot use a walker; an 89-year-old former Multnomah County Deputy Sheriff dependent on oxygen; and a stick-figure-thin man in Gresham who has lost 40 pounds to a lung ailment and can hardly scrape himself out of an easy chair.

Bud Washburn, 86, uses two hooks instead of hands. He lost one arm in a hunting accident at 16 and the other in a car crash in Highway 99, 33 years later. Unbowed, Washburn wrote a book called "I Have No Reason to Complain," about learning a skill -- restoring sculptures -- despite his disability.

He is losing Medicaid benefits for an assisted living home in Seaside, said his wife Loraine Washburn, in a phone interview. Loraine takes the couple's phone calls because Bud cannot hold the receiver.

Bill Watson, 59, languishes in a chair in his darkened room in a Gresham residential care home. A former automobile painter, doctors say he is ill from inhaling paint dust and primer fumes. He depends on oxygen from a machine in his bathroom that seems to sighs with a dry, rasping noise every few seconds as it compresses air.

"They may as well bring the coroner together with the eviction notice," Watson said.

Watson says he asked his doctor about Oregon's assisted suicide law, rather than face homelessness in his final months or years.

A few hundred people who lost benefits have appealed their cases, including Mary Carpenter, who now lives with Clifford in a room decorated with porcelain nicknacks and an oil painting of a biblical scene.

"Are they trying to separate us?" Mary plaintively asked attorney Linda Ziskin during a recent visit to discuss her case. A hearing is expected in June or July to decide whether Mary can remain in assisted living.