Three days a week, Ishmael, an elderly African American stroke patient, attends the Ruth Ann Rosenberg Adult Day Health Care (ADHC) center, one of about 330 such centers around California that Gov. Brown proposes to eliminate.
At the center, Ishmael, who’s last name was withheld, meets with a physical therapist, receives a nutritious meal, socializes with others -- important for reducing his depressing isolation -- and talks with a nurse, who monitors his condition and helps him manage his medications.
“I appreciate that the governor is painting a picture as honestly as I’ve ever seen done,” said Lydia Missaelides, director of the California Association for Adult Day Services (CAADS), in Sacramento. “The governor and legislature have tough choices to make, but I’d argue that this is a bad choice.”
Gov. Brown’s proposed 2011-2012 budget echoes attempts by former Gov. Arnold Schwarzenegger to completely eliminate the adult day health care program, which serves 37,000 frail, elderly and disabled patients under Medi-Cal, the state’s federal-state Medicaid program.
Among other major reductions in health and human services for California seniors are a 10 percent cut in Medi-Cal nursing home payments; elimination of the 41 Multipurpose Senior Services Program sites that keep 12,000 elders out of nursing homes as long as possible; and tripling of recent cuts to the state’s In-Home Supportive Services.
“What’s different from the last governor is that Gov. Brown is at least balancing his cuts with revenue,” said, Jodi Reid, executive director of the California Alliance of Retired Americans (CARA). “But I’m disappointed he came out of the gate with this hard-headed approach to very sick and vulnerable people.”
Besides Brown’s proposed $12.5 billion in spending reductions, he is calling for $12 billion in revenues, including a five-year extension (requiring voter approval in a special election in June) of about $8 billion in temporary tax increases that are scheduled to expire this year.
Missaelides stressed that ADHC center participants and their families “are already making tremendous sacrifices. These are people the state has determined need this help because it is medically necessary. Ending this care is wrong for both fiscal and human reasons.”
The cuts in community-based care programs, she emphasized, will particularly affect families from Hispanic, Asian and African-American homes because so many of those in low-income homes are also deeply committed to keeping elderly relatives at home and out of institutions, Missaelides said.
A 2010 CAADS report, for instance, described patients such as Ishmael and “Donna,”
age 70, a former Asian American poet. In 2007, a stroke left her dependent on others to wash, dress, use the toilet, walk or get in and out of a chair or bed.
Despite the effects of a stroke, she continues living with her daughter and son-in-law – both of whom work full time – and her two young grandchildren, thanks to the Mills-Peninsula ADHC center in San Mateo, which Donna attends five days a week.
Without adult day care, Donna’s family could not keep her with them, Missaelides said, adding, “Families we’ve talked to around the state are feeling devastated” by the governor’s proposal.
Others adult day health participants CAADS described in the report remain out of institutions despite the effects of multiple sclerosis, Alzheimer’s disease and other debilitating conditions.
According to the governor’s budget, slashing the program would save $176.2 million next year. However, the centers, Missaelides said, cost one-third the bill for nursing home care, and the state – which pays only $38 a day per person -- will lose the federal matching half of the full charge.
A nursing home would cost five times as much — over $70,000 a year. Also, only about 2,000 beds are available at any one point in California, far fewer than the 37,000 people in Adult Day Health Care. (The governor’s office estimates 27,000 participants, but Missaelides said the higher number is correct.)
“Many of these people will end up in emergency rooms and nursing homes, the most expensive kinds of care,” she said.
Missaelides cited the 2010 analysis by Lewin and Associates showing that a similar proposal by Gov. Schwarzenegger to eliminate Adult Day Health Centers actually would cost the state $51 million a year, not save money, she said.
In addition, she said, dismantling the network of centers would result in other uncalculated impacts. For example, the state would lose more employment and tax revenue, because most of the centers would shut their doors, emergency rooms would be further overburdened, the rapid increase of aging boomers—the first of who start turning 65 this year—will add to demand for community long-term care services within a few short years.
Further, Missaelides said, once the centers are zeroed out, “it will be impossible to put it back together again.” She explained that not only will experienced providers have to find new employment but the complex licensing and regulatory requirements to reestablish the adult day health network would make it too costly and bureaucratically arduous to recreate.
What alternatives might Gov. Brown consider?
Missaelides stressed that instead of dismantling a needed service network and likely costing the state more in the long run, the state should save more through greater efficiency. For instance, she said, “The state has five agencies regulating adult day health centers. We’re in favor of regulation, but this needs to be streamlined. There’s so much waste in having to deal with that many agencies.”
CARA’s Reid also noted that the governor released his budget the same day advocates for a single-payer health care system launched their 2011 campaign in Sacramento. Passed by the California Legislature in 2006 and 2008, the government-run health care system was twice vetoed by Gov. Schwarzenegger.
Even though single-payer and other public options were vilified as “socialized medicine” during the 2009 health care reform debate, she said, “single payer would have reduced the state’s health care spending by billions of dollars a year. We need to look to real solutions, not quick fixes that save nothing in the long run and leave families with no options.”
Gov. Brown’s plan still must make its way through the obstacle course of the state legislature, state and possibly federal courts and a special-election campaign to convince voters to support the governor’s tax referendum.
Stating “I’m an optimist, ” Missaelides went on to say, “Once the public sees the ramifications of the cuts, I think they will respond. The public cares about its seniors and the most vulnerable people among us.” And, she added, “I’m always hopeful.”
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