California’s Impoverished Elders Out of Health Care Options

California’s Impoverished Elders Out of Health Care Options

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SACRAMENTO, Calif. — For Colombian immigrant Stella Higuita, 63, who has arthritis, high blood pressure, a transplanted kidney and replaced knees, the ability to go to the community adult day health center (ADHC) represents a major part of her life.

“They give me treatments, therapy, food and advice for avoiding depression,” said Higuita. Three times a week she goes to the Yolo Adult Day Health Center in Woodland, 15 miles northeast of Sacramento.

The centers also enable family caregivers to drop off their frail loved ones for safe, reliable care, so they can continue working. Advocates for the ADHC program say many caregivers would have to curtail they work or quit their jobs—with lost tax revenue to the state—were the center’s closed.

“The centers are our guides for getting access to resources in the community and learn new activities. Sometimes it’s better than our families at home. I’m very upset, and praying that my center doesn’t close,” said Higuita.

$170 Million Savings Questioned

Claiming to save California $170 million a year, Gov. Jerry Brown signed a series of bills last March to eliminate the AHDC program, which supports more than 300 health centers around the state. The centers serve more than 37,000 elders, three-quarters of them on the low-income Medicaid program. They suffer from a range of disabilities and chronic illnesses, such heart conditions, Down’s syndrome, schizophrenia, Alzheimer’s dementia, Parkinson’s disease and bipolar disorders.

The California Association for Adult Day Services says that on average, seven-to-10 percent of ADHC patients are Latino, because the state’s Hispanic population is fairly young. But that percent would be on course to rise. The 65-plus Latino population will more than double in the coming years. And a recent report by the state health department and the Alzheimer’s Association shows that dementia will triple among Latinos and Asians in the next decade.

In a community environment, these patients, many of them immigrants, receive treatment in the form of therapy, psychiatric counseling, medication management linguistic and social support, food, transportation, and screening numerous health conditions.

In response to the elimination of ADHC, Assembly Member Robert Blumfield, D-Los Angeles, proposed bill AB 96, titled, “Keeping Adults Free from Institutions,” which the state legislature passed – and Gov. Brown, also a Democrat, vetoed it last Monday.

Blumfield’s bill would have provided $85 million – about half of the state’s cost for the ADHC program -- to assist California’s most vulnerable elders.

“We have a serious problem in front of us. Thousands of adult patients and their families that use these centers don’t know what will happen to them. That enormous insecurity is a real nightmare,” said Representative Blumenfield.

In his veto message, Gov. Brown states, “While my administration deeply shares the goal of Keeping Adults Free from Institutions, creating an ADHC look-alike program at this juncture is unnecessary and untimely. It does not address the immediate need to transition ADHC beneficiaries to other home and community-based services that would meet their needs, and would cause confusion for both consumers and providers about when an ill-defined KAFI program would be available.”

Brown added, “In order to ensure that there is enough time to transition to [other services], the Department of Health Care Services recently extended the ADHC benefit through administrative action until December 1, 2011, with federal funding approval.”

The problem, however, according to ADHC representatives, is that poor elders with disabilities or chronic illnesses have run out of options.

17 Centers Closed So Far

The California Department of Health Care Services is working on alternatives for the center’s patients, but the defenders of ADHC aren’t satisfied.

“There hasn’t been a single, deep, productive meeting, and there’s no will on the part of the administration to explore new options or ideas,” said Lydia Missaelides, director of theCalifornia Association for Adult Day Services.

So far this year, 17 centers have closed. It is expected that by the end of the year, more than 95 percent of the centers will have closed. More than a quarter of elders currently served by the centers are expected to move to long-term care homes as a result of the closures. But two-thirds of California’s nursing homes have said they do not have room for these patients.

Without the week-to-week monitoring and preventive care they receive at the centers, Missaelides and other experts say patients not able to get into the costly nursing homes will end up in and out of emergency rooms at great expense to the state’s Medicaid program.

Of the 17 ADHCs that have closed, seven were in the Los Angeles area (Glendale, Van Nuys, Reseda, Alhambra, Monterey Park and Compton).

It costs the state $1,050 per month for each individual at an ADHC center, compared with $5,913 per individual per month in a nursing home, where residents receive round-the-clock care not needed by most adult day care.

Elders who use ADHC services go to the center on average three times a week, such as Stella Hinguita, who attends her center from 10 a.m. to 2 p.m. Others require longer hours, five days each week.

According to Representative Blumenfield, if only one in five of current ADHC patients went to nursing homes, California’s cost would outweigh the savings achieved by cutting ADHC.

Nina Nolcox, an administrator at Graceful Senescence, an ADHC in Los Angeles, said, “We’re expecting more elders from the centers to saturate emergency rooms, there will be more hospitalizations and more abuse of elders who suffer from dementia. It’s very likely that they’ll be alone at home without anyone to care for them,” she said.

In June, Disability Rights California filed a lawsuit against the state for eliminating ADHC. A court will hear the case November 1, 30 days before the state is set to close ADHC centers.