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tion’s nursing homes are ‘substandard. ’”4 In 1978, according to

Vladeck, there were still nursing homes “with green meat and

maggots in the kitchen, narcotics in unlocked cabinets, and disconnected sprinklers in nonfire-resistant structures. ” 5 Over 72 percent of the nursing home population is female. Women in nursing

homes are generally widows or never married, white, poorer than

most of their peers (70 percent having incomes under $3000 a year

consisting mainly of Social Security benefits), and have several

chronic diseases. According to The New York Times (October 14,

1979), the average age of the person in such an institution is 82 and

50 percent have no family, get no visitors, and are supported by

government money. Conditions are most terrible in nursing homes

supported by government funding of patient care: nursing homes

for the destitute, for those on Medicaid. The policy of the United

States government is that old people must become paupers: * spend

any money of their own that they have, after which the government takes over; the paupers are unable to defend themselves

*See “Loose Laws Make Care of Aged Costly, ” by Gertrude Dubrovsky,

The New York Times, October 21, 1979. In a subsection called “How the

Programs W ork, ” Dubrovsky explains:

“As of April 1977, the last period for which such figures were available,

a nursing-home patient under Medicaid could not have an income greater

than $533. 39 a month. However, should this same person want to remain

at home and receive community-based health-related services, his monthly

income must be less than $200.

“Thus, Medicaid laws are biased in favor of institutional care.

“Morever, Medicaid imposes strict personal-asset limits of $ 1 , 500 for a

single person or $ 2 , 500 for a couple.

“To be accepted by a nursing home under Medicaid, a person must sell

his home, liquidate his assets and turn them over to Medicaid as a gift, in

which case he stays on Medicaid.

“Or, he may give the funds directly to the nursing home as a private

payment until the money falls below the allowable level. When that happens, the patient reapplies for Medicaid, but may be put on a waiting list. ”

against the conditions in the homes in which they are kept. Once

paupers, they must accept confinement on the state’s terms because

they have no money and nowhere to go. The state’s terms all too

frequently are neglect, degradation, filth, and not infrequently outright sadism.

The nursing home population is markedly white. Blacks die

younger than whites in the United States— perhaps the result of

systematic racism, which means inadequate health care, shelter,

and money over a lifetime. Blacks alone comprise a full 11. 8 percent of the U . S. population and yet only 9 percent of the old are people of color, including Asians, Native Americans, and Hispanics. N ationally, so-called nonwhites (including blacks) comprise

only 5 percent of the nursing home population. In New Jersey, for

instance, according to The New York Times (October 21, 1979), out

of 8, 683 beds in eighty nursing homes, blacks occupied 532 and

Hispanics or “others” occupied 38 (6. 5 percent). It seems that

blacks especially are left to suffer the diseases of old age on their

own and to die on their own; and that whites are institutionally