Editor’s Note: The following article is part of an innovative multimedia news package titled “Home Alone: Adult Health Center Cuts Devastate Elderly, Disabled.” It is a collaborative project developed by New American Media and NAM’s LA Beez, a consortium of Los Angeles ethnic-media outlets, in partnership with the CHFC Center for Health Reporting at USC. The multi-ethnic coverage chronicles the effects of California’s pending elimination of the state-funded Adult Day Health Care centers (ADHC). For a list of “Home Alone” stories with links, visit the LA Beez website or go to the Center for Health Reporting site.
LOS ANGELES — At the fringes of Historic Filipinotown, in the southwest portion of Echo Park near Downtown Los Angeles, stands the Silver Lake Adult Day Health Care (ADHC) Center.
From Monday to Friday each week, the center serves as a lifeline to more than 100 frail seniors, mostly of Filipino descent, who converge there to partake in health, therapeutic and social services.
Treated with respect and care, these elderly Filipino men and women enthusiastically participate in ADHC activities tailored to keep them physically and mentally fit.
Camaraderie flows between them and the center's health workers, and there is a palpable sense of community, of belonging together. It is evident along the walls where pictures of these seniors are seen smiling and having a good time in past events.
For many of these seniors here in Filipinotown, the Silver Lake ADHC is a second home, a second family.
An Endangered Community
This is an endangered community, however, at risk of closing its doors.
California MediCal funding for the ADHC program is set to end on December 1, forcing elders, people with disabilities, medical professionals, senior-care workers and the seniors’ adult children to brace for an onslaught of uncertain consequences.
"Our patients are getting stressed already," said Mila Anguluan-Coger, Silver Lake ADHC program director. She noted that state workers have asked the center's clients to fill out forms for their pending transfer to other programs.
"We have been telling our patients of the possible situation and that we are here to support and help them," added Angulan-Conger.
But for many the news that their second home was about to close its doors was a bitter pill to swallow.
"Paano na ako?" ("What will happen to me?") lamented Nanay Seling, 82, who suffers from mild dementia. "Mga kaibigan ko andito, malulungkot ako kung di ko na sila makikita." ("All my friends are here. I'm sad that I might not see them again.")
"Di ko kakayanin. Baka mamatay na lang ako," ("I can't handle it. I will die,") Nanay Seling whispered sadly.
Benjamin Villanueva and his wife Vicenta have been attending the Silver Lake ADHC Center since 2006 and have no plans to join another programs.
"Sa bahay nalang kami," ("We would rather stay at home"), said Villanueva. They are already old, he said, and it would be an added burden to them to meet and get to know new people.
"Malaki na tulong sa amin, lalo na sa asawa ko. Lumakas sya dito, kala ko nun mawawala na sya," Villanueva said. ("It was a great help for us, especially for my wife. She regained her health here. I thought she would not make it before").
He added, Villanueva "Malaking bagay yung bawat umaga may titingin sa amin at aasikasuhin yung mga karamdaman naming." ("It is a big thing that every morning that we come here, our health is being looked after.")
ADHC centers have been around since the 1970s in California. They were seen as an alternative to nursing homes or other medical institutions and a more humane way of treating the elderly population. The ADHC centers allow seniors to stay at home with their family – allowing family caregivers to keep working -- while also providing a place where these seniors can socialize and be given medical treatment.
Today, there are about 38,000 seniors and disabled adults in more than 300 ADHCs across the state, including 22,000 in Los Angeles.
Many of the seniors are low-income and have Alzheimer's disease of other dementias. They have arthritis and other diseases related to old age. Seniors statewide are supervised by almost 7,000 care providers, such as nurses, counselors, social workers and physical therapists.
Gov. Brown’s Broken Promise
With California, however, in financial stress with a deficit in the billions, California Governor Jerry Brown eliminated MediCal funding for the ADHC program. According to the Department of Finance, the cut would save about $178 million through 2012. [An analysis by the Lewin Group in 2010 found that the state would actually lose $51 million in the first year of the cuts, due to the higher cost of nursing home care and other factors.]
Upon eliminating the program, Brown had promised to create a "look alike" program similar to ADHC. But the Democratic governor reneged on the promise in July when he vetoed a bill that would preserved the program, but with half the funds, $85 million for the coming year.
Although Brown said on vetoing the legislation that he “deeply shares the goal” maintain the ADHC program, he added, “creating a new ADHC look-alike program at this juncture is unnecessary and untimely."
Brown did agree to extend the deadline from August 31 to December 1, to better prepare the seniors, their families and others affected by the ADHC closure.
"He lied," said Angulan-Conger. "Gov. Brown promised that he would sign that legislation and he didn't. Now many of these seniors will have no one to watch over them.”
She added, "Gov. Brown is a senior citizen himself. I don't understand why he would cut these programs for the seniors."
Despite the governor’s claimed budget saving, the ADHC-center cuts could take an enormous toll on families who rely on them, said Jenny Batongmalaque, executive director of the ERB Foundation and Filipino Veterans Foundation. She said she fears the service reductions will consign the community's elders and disabled to a life of misery and possibly an untimely death for some.
"This is their home," said Batongmalaque. She commented after a press conference in front of a recent seniors in Cerritos to rally support to extend the deadline again. "Many of these seniors are by themselves here and have no one to look after them if the centers close. They will be left out on the street with no support system."
Albert Chin of the Los Angeles Aging Advocacy Coalition said Brown offered an alternative called "managed care."
But Chin said the managed-care program, basically involving home visits by a health worker for an hour or two, neglects the community connection and togetherness of ADHCs.
Left Alone and Depressed
In fact, that togetherness and sense of community is what most seniors interviewed for this article say will be the one thing they will miss most if the centers close its doors. It's not illness or disease they are worried about, it's being lonely.
Bibiana Viernes, 86, is legally blind. For the past eight years, she has been going to the Silver Lake ADHC. Even when her family moved from Los Angeles to Sun Valley, she insisted on continuing to attend the Silver Lake ADHC because of the camaraderie she shares with other patients, her friends and family.
"What shall we become if the center closes? Of course, I will be left at home. Alone," she said tearing up. "I live with my son and his wife, who work to earn for their livelihood... Being blind what will I do? Of course, I'll do my best to survive, but then I become sad, lonely and depressed. And I will be frightened. Any single sound, I will be frightened very fast. What if there is a natural disaster like a fire, earthquake or strong winds? Imagine what will I do? I will panic and die at that instance. My co-seniors are the same in that situation."
Chin said aside from loneliness, families of these seniors would now become conflicted as to what to do with their aging parents. He predicts that many family members will leave a job to take care of their elders.
Rodolfo Quitason emigrated to the U.S. in 2009, and is now caring for his mother-in-law, who suffers from Alzheimer's. He said he would rather care for her full-time than enroll her in a nursing home.
"It's hard, but no Filipino would want to enroll their parent in a nursing home," said Quitason. "Iba na kung pamilya and mag-alaga." ["It's different if a family member would care for them."]
"Adult day centers have a place in our lives as we advance in years," said Batongmalaque. "It is not just for the clients, who directly benefit from it, but the working families or care providers who need respite from a 24/7 care of dementia."
She also expressed concern that the seniors and their families "may be further challenged with a dangerous course in long-term care at facilities or homes."
Hope in the Philippines
But there is an alternative, at least for aging Filipino-American veterans and their families.
For the dwindling number of Filipino World War II Veterans, the Tricare and Medicare health programs are both honored in the Philippines.
Tricare is medical insurance available to U.S. active military-service members, veterans and their families, in addition to Medicare. Both insurance plans can be used in the Philippines, but unlike Medicare, Tricare is honored in most accredited Philippine-based hospitals and health care centers. Medicare is honored only at the VA hospital there and for emergencies at other hospitals.
The U.S Department of Veterans Affairs (USDVA) opened its state-of-the-art outpatient clinic last January, the only VA healthcare facility in a foreign country, in Metro Manila.
The $30 million facility is staffed by an all-Filipino staff of 230 doctors, nurses, medical technicians and administrative personnel, who support eight American supervisors.
The outpatient clinic offers 17 specialized services suited to veterans' needs, such as heart checkups, diabetes care, treatment of war injuries, provision of prosthetics and counseling for post-traumatic stress disorder (PTSD).
For qualifying veterans wishing to retire in the Philippines, they also can receive 75 percent of their Supplemental Security Income (SSI), provided to low-income individuals.
Segundo Bathan, 84, a former guerilla fighter, plans to return to the Philippines after living alone in the U.S. for almost 14 years.
He explained, "Pag magsarado na ang Silver Lake at nakuha ko na yung pingalalaban kong PTSD benefits uuwi na ako sa atin." ("If Silver Lake closes, and if I get my PTSD benefits, I am going home.")
For nonveterans, U.S. Medicare PH, a Filipino American group, is optimistic that its drive to make U.S. Medicare services portable to the Philippines will succeed by December 2012.
Quitason said that Medicare portability, if approved, would be good news.
"I would rather retire in the Philippines than face uncertainty here in the U.S.," said Quitason. "Even with lesser benefits, costs are cheaper in the Philippines."
Eric Lachica, the organizer of U.S. Medicare PH, has met with U.S. Reps. Steve Austria, R-Ohio, and Jim McDermott, D-Wash., members of the House Ways and Means Health subcommittee. Both have expressed interest in the proposal because of its potential cost savings.
According to the group's data, Medicare would spend only $8,000 for open-heart surgery in the Philippines, compared to $34,801 for the same surgery in the United States. Total hip replacement, meanwhile, would cost only $1,500 in the Philippines as opposed to the U.S. tab of$23,588. The figures do not include physician fees.
"This is a big help to the U.S. economy. I believe we can convince them, especially with the cost-cutting the U.S. needs to do now," Lachica said.
Come Dec. 1, barring a miracle, the doors of their homes will close.
That means for seniors like Wilhelmina Presto, 77, who admits she will miss her daily hour-and-a-half train ride from Fontana to Los Angeles to attend the Silver Lake ADHC, there's only one thing they can do.
"Just pray and hope our leaders will have compassion for us," she said.