New health law not meeting needs of the partially blind
Gladys Dixon can peel potatoes for dinner, but she can't cook them herself. She's 71 and her eyesight has been eroded by cataracts, so her son has to operate the electric stove.
When Dixon goes into the hall outside her Dorchester studio apartment, she can't see her neighbors' welcome mats, which snag the wheels of her walker.
''It happens quite a bit. I get hung up," she said with a slightly embarrassed smile, in her dimly lit unit at the Boston Housing Authority's Codman complex recently.
Dixon's plight is shared by tens of thousands of Massachusetts residents, most of them elderly. Though not legally blind, they have been disabled by severely blurred, dark, or spotty vision.
And, advocates say, they have been virtually ignored in the sweeping healthcare reform legislation signed into law last month by Governor Mitt Romney.
The law focuses most new spending on hospitals, which lobbied heavily for its passage and will receive $540 million in increased Medicaid reimbursements during the first three years and $270 million annually after that. Much of the money will be consumed by healthcare that is dependent on costly high-tech procedures and equipment.
If people like Dixon were legally blind, they would be eligible for a variety of comparatively inexpensive government assistance programs.
For example, they would receive rehabilitation services through Medicare and devices such as special lights and magnifiers from the Massachusetts Commission for the Blind.
But the partially blind don't qualify for such aid. Instead, they are stranded on the margins of the healthcare system, forced to live in a world where even stoves and welcome mats pose hazards.
In addition, funding to provide eye exams and eyeglasses for beneficiaries of the state Medicaid insurance program has been cut by more than half during the past five years, from $10.9 million in 2002 to a projected $4.9 million this year. Romney administration projects that funding for eye exams will increase slightly in 2007, to $5.4 million.
Timothy Murphy, state secretary of health and human services, was unavailable to comment, said his spokeswoman, Brigitte Walsh.
''We have a healthcare system in this country which denies millions and millions of individuals with partial sight the potential rehabilitation services that could help them maintain their independence and quality of life," said Dr. Louis Frank, chief of geriatric eye care at the New England Eye Institute in Boston, the teaching affiliate of the New England College of Optometry.
About 105,000 Massachusetts residents and 2.3 million nationwide suffer from severe vision problems. Technically, they have ''low vision," meaning visual acuity between 20/70 (the threshold at which it is illegal to drive a car) and 20/200 (the definition of legally blind). Most suffer from cataracts, glaucoma, macular degeneration, and diabetic retinopathy.
Dixon receives help from her son, who is living with her temporarily while she recovers from hip replacement surgery. She recently received eyeglasses from a nonprofit effort called the Elders Right to Sight Project.
But Dixon could potentially maintain her independence and health longer if she had such things as brighter lights, talking clocks, a magnifying glass to read prescription bottles, books on tape, and special knobs that would allow her to adjust her stove by touch. A social worker could advise her how to reduce clutter in her small apartment, improve the lighting in the hallway outside, and remove obstacles.
Without that kind of basic assistance, people with partial sight run a greater risk of broken hips, badly managed diabetes, poor nutrition, and depression -- all of which result in expensive hospital and nursing home stays, said Frank.
MAB Community Services, a nonprofit agency in Brookline that provides home assessments and assistance to about 3,000 people each year, estimates that avoidable complications of diabetes and untreated depression among the partially blind add $300 million to the state's healthcare costs annually.
By contrast, it would cost about $20 million to provide assessments and support to most of the 105,000 state's partially blind residents.
The state does operate a modest program through the Massachusetts Rehabilitation Commission, which provides assistance devices to people with disabilities, including about 100 people with low vision, said commissioner Elmer C. Bartels.
Several nonprofit organizations attempt to fill the gaps in services for the partially blind, but say the needs far exceed their capacity.
The Greater Boston Guild for the Blind provides an adult care facility in West Roxbury caring for about 40 people with impaired vision. The guild also makes presentations at senior centers and apartment complexes, reaching about 350 people in the last year, said Annemarie O'Hearn, the guild's vice president for administration and planning.
''This is not the level of intervention that we really want and need to have, but we think it's better than nothing," O'Hearn said.
MAB officials expect the number of people needing assistance to rise, as an anticipated diabetes epidemic increases the incidence of diabetic retinopathy, which results in damaged blood vessels that create black spots in a patient's range of vision. That makes it difficult for them to read glucose meters, syringes and prescription bottles, maintain a proper diet, and inspect their feet so diabetes-related sores don't become seriously infected.
''A visually impaired person may not take his or her medication, so that person could end up with an acute diabetic episode," said Ellen Lutch Bender, president of Bender Strategies, a healthcare consulting firm that advises MAB Community Services.
''The short amount of money it would cost to enhance the quality of life and safety of people who have sight impairments is so small compared to the costs associated with not helping them," she said.
Mattie Louise Jones, 74, who lives down the hall from Dixon and has cataracts, recently received from MAB a tape recorder to listen to books, a $15 desk lamp, and a large magnifying glass that cost less than $10.
On a recent morning Jones demonstrated how the glass has allowed her to read the Bible.
Ruth York, a retired University of California, Davis, professor of French literature, found MAB Community Services after contacting the town offices in Onset, where she lives.
York, 81, said she is determined to remain independent despite macular degeneration, a disease that causes deterioration of the retina.
She has a machine that displays print from books on a large screen. York also has a talking scale and three talking clocks. She gets magazines, even though the print is often too small for her to read. ''I still subscribe to the Smithsonian, The New Yorker, and Vanity Fair," York said. ''It's just nostalgia. I don't want to give it up yet. It would be an admission of defeat somehow."
Christopher Rowland can be reached at crowland@globe.com. 