California’s Adult Day Health Care System: Transition to Nowhere
By Assemblymember Mariko Yamada
Chair, Assembly Committee on Aging and Long Term Care
Almost forty years ago, California pioneered a system to keep frail elders and persons with disabilities in supportive community day settings. In response to the highly publicized, disturbing stories of nursing home abuse in the ‘70’s, the Adult Day Health Care Center (ADHC) model emerged as a more humane and less costly alternative.
Today, there are 37,000 low-income nursing home-eligible seniors and disabled adults enrolled in over 300 ADHC’s throughout the state. These clients are served by over 7,000 care providers—physical therapists, nurses, social workers, nutritionists and more—who provide a constellation of health and social service interventions to keep adults free from institutions. This daytime care model is as important to a frail elder as childcare is to a toddler. In neither case is it moral, ethical, or legal to leave a dependent individual home alone, unsupervised and without care. Also, in each case, a working adult family member has some peace-of-mind—if he or she is still lucky enough to have a job in today’s economy.
The late 90’s saw an explosion in adult day health care, after the Legislature lifted the restriction against “for profit” centers. Regrettably, relaxation also allowed unscrupulous operators to proliferate, particularly in southern California. By 2004, the Legislature enacted a statewide moratorium on new ADHC Medi-Cal certifications, effectively capping program enrollment.
Since then, an ever-growing population of impoverished and disabled older adults, many with complex chronic conditions, along with the State’s continuing rocky financial condition, has put the “optional” adult day health care benefit at the crux of the annual game of “budget chicken”. Both Republican and Democratic governors have proposed either severe cuts or outright elimination of the program. Along the way, the courts have provided measured but short-term relief while ADHC clients, their families, and those who cared for them were cast-about in the stormy seas of fiscal uncertainty.
In March of this year, I, along with every other Democrat in the Assembly, voted to support Governor Jerry Brown’s proposal to eliminate the optional ADHC benefit in California. It is a vote I regret daily. The unified Assembly majority support came tempered with the belief that our Governor would provide for a scaled-down transition program, “Keeping Adults Free From Institutions” (KAFI). KAFI would continue the program using the underlying principles of the adult day health care system—an integrated model of social and medical services.
Incomprehensibly, on Monday, July 25, the Governor vetoed AB 96 (Blumenfield, D – Van Nuys), legislation that would have allocated $85 million, with 100% federal matching funds doubling to $170 million, to establish the “KAFI” program with eligibility based on medical acuity. Our scaled-down approach vanished.
Although recent state and federal administrative actions have extended the ADHC benefit to December 1, an expected court hearing challenging the original ADHC cuts has been continued to November 1, plunging existing centers further into chaos and confusion.
Without a clear transition vehicle, and a judicial decision expected less than 30 days prior to the federal deadline for elimination, 17 ADHC’s have already closed and many more will not risk keeping their doors open. The Assembly Committee on Aging and Long Term Care which I chair will convene a hearing on Tuesday, August 16 at 2 p.m. in the State Capitol to assess the costs and consequences of these closures.
Over thirty years ago, State Senator Henry Mello issued a paper establishing the need for 600 adult day health care centers in our state. Yet now, we have less than half that many in operation, with more closing each day. The “silver tsunami” is at our doorstep; the fastest growing age cohort is 85-100, and thousands of persons with autism will be coming of age in the next decade. Instead of protecting and preserving a cost-effective, integrated system of community care, we are in the process of destroying not only the innovation, but the spirits of all those who have fought so valiantly to continue this program. Once this now maimed system is eliminated, and clients are shunted to less appropriate and more expensive services, many family members will have to quit their jobs to care for their aging or disabled loved ones. This, along with the ripple effects in a bad economy puts our State in a more precarious fiscal situation. Beyond the financial deficit we face, the elimination of the adult day health care model in California reflects a moral deficit from which I am not sure we will ever fully recover.
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The only viable ainertatlve to the health care we have now would be a single payor system, but that would mean closing down approximately 1,000 health insurance companies and would add tens or hundreds of thousands of workers to the unemployment rolls, to replace all of them with a single federal government payor and inefficient civil service workers.To spend over one trillion dollars to just add a government option is fiscally irresponsible and will cost more annually than the system we have now.If our system is so bad why do people from around the world, in particular England and Europe, come here for treatment which they can’t get or would take too long with their free government health care?
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President Obama is fighting giaanst yellow journalism.Who wants Canadian Health system? They are the worst in the world. They don’t care. They are just beauarctratic Canadian Officials who are truly non-democratic! But President Obama cares and he is not advocating Canadian Health system! He again ensured us in town hall meetings in his loud and clear voice. He wants to help the people. He is peoples friend! It is not so difficult to understand such a great and brilliant leader! People must not believe in yellow journalism of liars.I am so glad that President OBAMA realized the dirty problems behind his hard toil to give american a real health system. Some media people always make a day to night’ and a night to a day’. Those narrow media people just practice yellow journalism! They don’t like the truth and they can’t handle the truth. So, they go in wrong ways to explore! They are in hallucination and want to create news for their survival at the cost of peoples sufferings, miseries of political, economical and health hazards.I am with the loud and clear voice of the president. We all should stand up and fight giaanst the wrong propaganda of nasty media people. They make news from fabrication of scary tales to scare the people only to dominate them. They are hungry journalists and want to bite on peoples coins! That’s all! Such must be unlawful!Like always, my thumb is up for the dear President and for his good works.
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I loved reading about Adult Family/foster care rsreuecos. I work as an occupational therapist with adults who have developmental disabilities. One of my passions is to discover what their dreams are and how to have those fulfilled. The Adult family Care program sounds like a way for parents to have their dreams fulfilled by being able to continue to care for their child. Thank you, Kathy and everyone for the work you are doing to make this happen for families.Emily Berheide
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otherwise. total population: 77.04 lraesmaye: 74.77 yearsfemale: 79.44 years (2004 est.)With regards to the quality of their health care, see the :Many countries of the former Soviet Union have very high physicians per capita rates. Cuba also has a high number, and ranks third in the world, with 530 doctors per 100,000 people, behind Monaco (664) and Italy (554). The high number of physicians appears to be at least partly responsible for Cuba’s excellent level of health care. Cuba has a very high level of Life Expectancy, despite the fact that it has one of the lowest spending rates on health care.From :Cuba also boasts the highest rate of public health service in Latin America and has one of the highest physician-to-population ratios in the world. Alone remarkable for a developing country, these feats are even more extraordinary considering the context of a US embargo that’s been in effect since 1961. Because its access to traditional sources of financing is seriously hindered by the sanctions, which until rec- ently included all food and medicine, Cuba has received little foreign and humanitarian aid to maintain the vitality of its national programs. And herein lies the paradox of Cuba’s health care system: because Cuba has so few resources, prevention has become the only affordable means of keeping its population healthy.However, all is not rosy. Since the collapse of the Soviet Union Cuba has fell on hard times. From a summary of a report from :But ten years later two studies, conducted by the American Public Health Association (APHA) and the American Association for World Health (AAWH), indicate the Cuban people, especially the children, are now facing dangerous shortages of medicines and medical supplies. Although some of the blame can be placed on the dissolution of the Soviet bloc countries and inefficiencies within Cuba, the APHA and the AAWH find that the fault lies primarily with the U.S. embargo of Cuba.Like I started my entry, data points exist for both conclusions, but I’m convinced that the free market won’t solve the health care crisis. Cuba isn’t a paradise, but they have good health care.
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Personally my experiences at the VA maleny the North Chicago VAMC has been a nightmare! I read the above statement by the husband and wife that utilize the same VAMC and love the place, good for you. But I encourage everyone to think twice about your healthcare. When you are wrongly dianosed with stage IV cancer by a VA Oncologist and he bases this medical opnion solely on reading a ct scan and not ordering further biopsy’s or other tests to confirm it, and then when he says that he wants to have a pick line installed right away and begin chemotheraphy weekly, without proving that a cancer has returned, and that he will make you comfortable with pain meds until you pass . Well if you want this type of care be my guest, as for me and other rational human beings, we seek second opinions rather than a doctor’s hunch about a cancer diagnosis. If I had listened to Dr. Mehta’s opinion at the North Chicago VAMC 4 years ago I would be dead today. Instead I sought another opinion based on science, had surgery and am currently in remission. I did follow my new onclogist’s advice which was to never under any circumstances see another VA oncologist at the VAMC North Chicago. I would just clearly say that without a doubt that the VA’s quality of care and standards are not the same as the civilian sector, but this is based on my experiences and those of my sister who is another veteran. I also believe that if you have only a couple of minor health issues rather than having many complex issues your experiences will be different. In my case I need to see many specialist’s because of the cancer and susiquent side effects from the treatments. If a person is in general good health then there viewpoint could be completely differnt. One thing else, trying to get an appointment is a disaster as well, I thought that if you wer rated at 50% or greater then you were supposed to take priority over other vets that are not? The North Chicago VMAC doesn’t seem to follow this system, as I am instructed to have follow-up appointments and yet it’s nuts.
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I reply about the 50% of medical care cmnoig from the Gov. As you can see it has not reduced the cost of health care for those with private insurance. What I would like to know is if half of the money is being paid out for medical expenses is government tax monies how much of the population is being served? Is this huge amount covering or giving care to at least half of the nations population? I would think not. Then how does ANYONE think that the government would do a better job at health care then the private sector?A lot of that money is going to private doctors in the form of those on Medicaid and medicare it is government bureaucracy in the private sector and the huge expense in the VA hospitals spending that 50%. They do some good work there is no doubt but they also waste an enormous amount or money and resources. This comes first hand from being with my father for the past 20 years in his dealing with the abhorrent VA hospital in GA. If you want to see socialized medicine just go down to a clinic or VA hospital in your home town. You will not be such an advocate after that. If our healthcare’ system is broken and half of the money is our government tax monies then there is something wrong with the government branches of the handling of it. No small output I am sure due to the healthcare being paid for every government employee. We need to seriously scale back on those on the government payroll- we cannot afford so many employees.We must also be accountable to what we do to our own bodies. You are what you eat, and if you eat highly processes foods you are doing much more harm then good.