By Assemblymember Mariko Yamada –
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.
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.
Assemblymember Mariko Yamada represents California’s 8th Assembly District, including portions of Yolo and Solano counties. She has chaired the Assembly Committee on Aging & Long-Term Care since 2009.
It seems ironic to me that this article comes in such close proximity to the discussion we just had about the devastating effects of the widespread closure of mental hospitals without appropriate funding of programs needed to support outpatient care.
This would seem to me to be a repeat of the same situation but with our elderly and their families taking the hit. I will be very interested in hearing your take on this Elaine. I would especially like to hear your thoughts on how to activate “the village” you referenced to help those directly affected.
Thanks for the confession, now how about some real penance ? “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.”Sort of like community mental health care evaporated after the state closed mental hospitals . This state’s legislature has become more ” do nothing ” than Texas’ ! Democrats have spent the last two years, quite accurately, blaming the republicans for stalling any progress on the economic crisis . Since it is obvious that nothing will be done in the capitol building, get on the road and tell people why you can’t get anything done , who is gumming up the works and how they benefit at the state’s expense . Realize that this would require more than just showing up for photo ops and sound bites . You need to actually engage the people in honest and rational discussion . You need to shine the light on all the posturing hypocrites who rant endlessly about fiscal responsibility, while allowing the state’s most important assets, its people, to wither from neglect !
[quote]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.[/quote]
Sounds to me like legislators were blindsided by a less than honest Governor. This just goes to show that as a legislator, you have got to get all the appropriate language within one bill, before signing off on it. In other words, you don’t sign anything on the “promise” that something else will be done. Instead you make sure the “promise” is more than a “promise” – YOU GET IT IN WRITING WITHIN THE SAME BILL. I don’t pretend to know all the legislative ins and outs, but this seems very basic to me…
[quote]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.[/quote]
If it were not for the public interest lawyers fighting this issue tooth and nail, ADHC in CA would be dead right now. Twice before public interest lawyers have been able to save the ADHC model in CA, when it was slated for elimination, based on the tenets of the Americans w Disabilities Act (ADA) and the Olmstead decision, that directs frail elders and the disabled to be kept in the least restrictive environment as possible. Since the public interest lawyers won twice before, it is my sincerest hope they will win again. But the economic situation is far different, so I don’t know if that will be a consideration by the courts.
But stupidly, it is far cheaper to place a person in ADHC, than to institutionalize them in skilled nursing, which is something I am sure the public interest lawyers will point out. Further, there are not enough skilled nursing beds to even place all these people on the verge of being booted out of ADHC. So what is the state going to do if the ADHC doors close? Put these frail elders and disabled out on the street? I very much doubt that is even legal – it is known more familiarly by the term “dumping” and is not permitted by other agencies/entities like hospitals. A discharge plan is required. So what is the “discharge plan” for these frail elders and disabled Governor Jerry Brown? Mr. Moonbeam (the name the Governor had been known by previously) must be getting some very, very poor advice somewhere to have vetoed AB 96.
Fortunately Yolo Adult Day Health (YADH) is keeping its doors open so far. Even if those low income clients who are covered by MediCal are denied ADHC services, private pay clients can still attend YADH for now.
[quote]I would especially like to hear your thoughts on how to activate “the village” you referenced to help those directly affected. [/quote]
The village has already been activated. Mariko Yamada is working diligently on this issue, as are the public interest lawyers, as is the Yolo County Commission on Aging & Adult Services (YCCAAS) (I’m Vice Chair), Supervisor Jim Provenza, YADH administrator Dawn Purkey, the YCCAAS Advocacy subcommittee of which I am a member, Public Guardian, IHSS, and other state and national organizations are all very much fighting to save ADHC in CA. But the Governor is stubborn, as are certain legislators who only see budget numbers in isolation. I just do not understand how one cannot see that having ADHC centers is cheaper than institutionalization. The only plausible explanation I can come up with is that these legislators proposing the elimination of ADHC figure the clients will die off sooner than later, and therefore the legislature will save the money that way. Call me cynical, but that’s how I see it…
Without speculating on Jerry’s motives, I’m afraid you are right on this one Elaine . But they hate bad press and this seems like an issue that could generate lots of press, especially if the press gets visuals ! (Such as middle aged workers and their parents demonstrating at the Capitol ?) You wouldn’t have to block any freeways !;-)
[quote]Without speculating on Jerry’s motives, I’m afraid you are right on this one Elaine . But they hate bad press and this seems like an issue that could generate lots of press, especially if the press gets visuals ! (Such as middle aged workers and their parents demonstrating at the Capitol ?) You wouldn’t have to block any freeways !;-)[/quote]
Love the comment about blocking the freeways!
Mariko, I am very suprised you voted “voted to support Governor Jerry Brown’s proposal to eliminate the optional ADHC benefit in California.” Knowing your track record, and having directly seen you at work scrambling to fill a gap in a hot meal program in Woodland a few years back, I believe you must have had a truly compelling reason to vote as you did. Could you share this here? In the meantime, what can we do to help now?
[quote]Mariko, I am very suprised you voted “voted to support Governor Jerry Brown’s proposal to eliminate the optional ADHC benefit in California.” Knowing your track record, and having directly seen you at work scrambling to fill a gap in a hot meal program in Woodland a few years back, I believe you must have had a truly compelling reason to vote as you did. Could you share this here? In the meantime, what can we do to help now?[/quote]
I don’t want to put words in Mariko’s mouth, but I presume she voted to eliminate ADHC – ON THE PROMISE that a KAFI ADHC model would be substituted in its place. What she did not realize is that she was being set up – there was not intention of carrying out the UNWRITTEN (into the bill) “promise” of a KAFI ADHC replacement model…