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by Abigail Van Buren

DEAR ABBY: You printed a letter recently from a woman who didn't understand why people would not want to go to a nursing home when they get old. You responded that "many are hesitant to give up their independence and familiar surroundings" or to "surrender control of their lives," and noted that assisted-living facilities offer varying levels of care that are a more attractive alternative.

There can be a far better choice: A bill currently before Congress offers senior citizens and persons with disabilities the option to maintain their independence and control of their lives while remaining in their own homes -- or the option to choose a congregate (group-care) facility if that is their preference.

This bill is the Medicaid Community Attendant Services Act (HB2020). The bill, known as MiCASA (Spanish for "my house"), introduced by Speaker of the House Newt Gingrich and co-sponsored by House Minority Leader Richard Gephardt, would amend Title XIX of the Social Security Act-Medicaid to create a new option called "Qualified Community-Based Attendant Services."

Anyone eligible for a nursing facility or intermediate-care facility services for the mentally retarded would be allowed to stay in their own home and receive attendant care to assist them in their home, workplace, recreation or religious activities. The money follows the individual. It can be used to move out of congregate-care settings or to avoid having to move in. The need for assistance in daily living and health-related tasks will no longer mean that people have to give up their familiar surroundings or their independence.

This bill will benefit everyone who is disabled or will ever have a disability or be old -- and that's everyone. To secure the right to choose, call or write your representatives in Congress and urge them to co-sponsor and vote for this important bill. -- GAIL B. KEAR, EXECUTIVE DIRECTOR, LIFE-CIL/CENTER FOR INDEPENDENT LIVING, BLOOMINGTON, ILL.

DEAR GAIL: Thank you for alerting me to this pending legislation. The vast majority of the mail I received in response to the letter from "Living It Up to the End" contained horror stories about the conditions faced by seniors when they enter nursing homes. Of course there are exceptions, but the MiCASA bill appears to be the answer to countless prayers. I hope we'll hear more about it in the near future. Read on:

DEAR ABBY: As an advocate for nursing home residents, I'm aware of cases throughout the country of abuse and neglect in nursing homes, as well as violations of residents' most basic rights.

Nursing home residents and their families never call me to share the wonderful experiences they have had with a particular facility. They call to report that they were sexually assaulted by a staff member or left to lie in their own waste for hours until someone could change their sheets, or they were refused re-admittance to the nursing home after they were sent to a hospital emergency room.

While some very good facilities provide excellent care, many poor nursing homes violate the law on a daily basis. "Living It Up" should spend time visiting local nursing homes. I'm sure many are neither "clean" nor "pleasant." Until or unless "Living It Up" has resided in a nursing home, she should never pass judgment on those who refuse to consider a sterile and often undignified environment an "option" to living in their own homes. -- ARIZONA ADVOCATE

DEAR ADVOCATE: Conditions in nursing homes will not improve until families make it their business to stay in close touch with the residents, visiting frequently and at various hours -- and taking their relatives out as often as possible to prevent them from becoming isolated. Carrying out that responsibility may not be easy, but it's vitally important.

Good advice for everyone -- teens to seniors -- is in "The Anger in All of Us and How to Deal With It." To order, send a business-sized, self-addressed envelope, plus check or money order for $3.95 ($4.50 in Canada) to: Dear Abby, Anger Booklet, P.O. Box 447, Mount Morris, Ill. 61054-0447. (Postage is included.)

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