One of the biggest barriers in the way of transitioning people from institutions to community based service is fear of the “woodwork effect.” This effect is a theoretical idea that many people are cared for at home by friends and family and are not at risk of institutionalization. However, if states were to offer good community based services, these individuals would avail themselves of these newly available services. They would in effect “come out the woodwork.”
What is never considered is that such free care isn't truly free. One out of every five households in the United States have at least one member who needs help with daily tasks according to the Family Caregiving Alliance, This care work is performed 44.4 million unpaid personal care assistants. The majority of informal caregiving is preformed by women, according to the Gender and Health Collaborative Curriculum.
Who asks these women if they wanted to be placed in the role of permanent caregivers? Who asked the people with disabilities they care for if they desired to have a relative know about their most personal daily behaviors? Most likely, the answer is no.
Free care limits the employability of both women and people with disabilities because both people's schedules must be taken into account and there is often no room to accommodate the employer's demands, It also limits the free will of disabled people because they are often forced to go along with what the caregiver wants or risk not getting the care they require.
One might question if the woodwork effect is even a fact? According to the results of the community based service programs in Oregon and Kansas, the answer is no. Susan Dietsche, Assistant Administrator at Senior and Disabled Services Division of Oregon's Department of Human Resources. Ms Diesche reported, “Although there were some start-up costs involved in the beginning, for many years now our statistics back the 3:1 ratio. This means we serve three people in the community for every one person in a nursing home." In Kansas, providing home care saved the state $2000 per person per year,
However, a bigger question remains, even if this effect exists, is it fair to make people with disabilities and their families suffer with no services? As ADAPT activist Stephanie Thomas testified to the Energy and Commerce Committee Subcomittee on Health on January 16, 2008, “We hear about fear of the 'woodwork effect' an insulting term that actually refers to the unmet need of real live human beings. We are not cockroaches and this is not pest control.”
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