Elderday, adult day health care breathe easier

California is one of only a few states that covers adult day health care programs for Medicaid recipients. Adult day health care centers provide daytime supervision for people with cognitive, physical and social impairments. They also administer a variety of prescribed therapies. Since May, supporters of adult day health care have been rallying—first against a cut of all Medi-Cal funding. More recently, they rallied against a proposal to cap the number of days Medi-Cal recipients would be able to attend these programs. From Elderday, an adult day health care program in Santa Cruz, Christopher Connelly has this story.

Elderday is the only adult day health care program in Santa Cruz County. The center has about 150 regular paritipants over the age 50 with a variety of physical, cognitive and social impairments. A typical day begins at 8 or 9 in the morning, when the participants are picked up from their homes by bus and driven to the facility.

Elderday does everything that any adult daycare center does, providing seniors a chance to socialize with each other and with staff members, a variety of activities to keep them sharp and meals and supervision while their families and caretakers work during the day. But what separates adult daycare programs from adult day health care centers is the range of therapeutic and health services that are offered at programs like elderday. They provide physical and occupational therapy, case management, mental health services, excercize, transportation, podiatry and nursing.

Sheri Anselmi is the director of Elderday. She says that in California, there are over 33,000 participants at around 330 adult day health care facilities. While most participants are seniors, the facilities can serve adults of any age.

Starting last spring, anselmi and other adult day health care supporters have been fighting to keep Medi-Cal funding intact. She says that the battle began in may, when Governor Schwarzenegger proposed to cut all Medi-Cal funding of adult day health care to help balance the budget. Although a total cut didn’t gain traction, the idea was revised. In July, lawmakers and the governor passed the budget revision package that would scale back the number of days Medi-Cal would pay for—from five to three days per week.

Anselmi says although it was not a total cut, the effect of the cap on her facility would have been severe.

A law suit was filed in august on behalf of three women who attend adult day programs paid for by Medi-Cal five days a week. They argued that the cuts violated the Americans with Disabilities Act and federal Medicaid law because it failed to provide alternative care and was therefore a cut in medically necessary services. They said that the cap would lead to institutionalization in nursing homes in most cases.

The case was heard on September 9^th in federal district court in Oakland.

On September 10^th, Judge Sandra Armstrong ordered an indefinite suspension of the cap, saying that scaling back services would cause irreparable and immanent harm to the people who rely on them, and that the state was obligated to provide alternative services that would prevent insititutionalization.

The State Budget and the Safety Net

Safety net nonprofits, the organizations that provide food, clothing, medicine, health and mental health care for central coast resident have caught a dual edged attack over the past couple years. Climbing unemployment, food and energy costs meant more clients for food and other direct assistance just as the state legislature halted nonessential checks last summer for a period of weeks. Many of these organizations contract with the state or with state programs through local governments. All indications are that this squeeze between increased demand and uncertain state funding has intensified in the proceeding 12 months.

In health and mental health care nonprofits, these challenges build complexity as the state chooses to opt out of programs with generous federal funding and release prisoners early from jails and prisons. In Santa Cruz and Monterey counties, patients receiving state subsidized addiction treatment
will see fewer effective options. In particular, residential rehabilitation may fall well out of reach. The potential loss of assisted day programs like Salud Para la Gente’s Elderday may leave families with few options for care for family members who need some nursing help during the day. As Sarah Clarenbach noted in her post on this blog, the loss of the state portion of adult dental care under Medicaid probably means people who need treatment for cavities will go without.

Each of these are cases that illustrate the strategic effort on the part of safety net nonprofits to provide subsidized services that help people with limited resources avoid devastating outcomes like imprisonment, hospitalization or placement in an assisted living facility. Outcomes that end up costing society more in moral terms and probably in fiscal terms.

April topic: cuts to Medi-Cal optionals – J.D. Hillard

According to the current state budget, cuts to Medi-Cal optionals would take place in June. State funding for psychological, podiatric, dental and other services for indigent patients would be eliminated. Recent reporting differs as to whether the federal stimulus may contain funds that will make up some of this funding.

How does the uncertainty around this funding affect staffing and services? What direct effects of a cut would you expect in your agency? How would patients experience these effects? Who are the patients who benefit from this funding – can you describe the conditions the need help with, the circumstances that lead them to need government assistance? When patients seek services that have been defunded what will they encounter? If defunding leads to emergency room visits, what outcomes are likely for patients and for hospital resources?

J.D. Hillard

Talk and Information Producer KUSP