'The Unkindest Cut'

Last night we listened online with others as guests on KALW’s “City Visions” discussed what will happen to the 34,000 to 37,000 families impacted by the elimination of Adult Day Health Care in California. From the experts and those who called in to the segment titled "The Unkindest Cut," it’s apparent there’s already some movement.

One hospital ER worker has seen an increase in elderly patients since a nearby adult day health care center closed due to budget cuts. Another noted that there’s now a 4 to 6 months waiting list for skilled nursing homes in her area since the local ADHC closure created sudden demand for a limited number of beds.

To those locally who are wondering about our Glenner Centers: We intend to remain open!

The first half of the live broadcast focused on how we reached this point, with the legislature first voting to eliminate ADHC and then the governor vetoing it’s replacement, Keeping Adults Free from Institutions (KAFI).

Assembly member Mariko Yamada (D-Davis), who chairs Chair of the Assembly Committee on Aging and Long-Term Care, told the audience she never would have voted as she did had she suspected Gov. Jerry Brown would veto KAFI.

“It is a vote that I will regret for the remainder of my career,” she said.

During the show, Yamada noted the “silver tsunami” that’s arrived -- referring to the vast number of Baby Boomers turning into senior citizens and requiring more long-term care options. Even with the large number of ADHC recipients today, she said, “we do not have the capacity to place everyone that would need to be institutionalized.”

Someone who operates an ADHC within the Chinese community of San Francisco called to say 43 percent of residents in his area live alone, do not speak English and do not want to give up their family doctor, let alone move to a facility. “We provide medication management and we remind them to take medicine at hime. If we’re eliminated, I worry they will become confused with medications.”

Michelle Pope, who operates Alzheimer’s Services of East Bay, was more blunt in her predictions.

“I think it’s going to be catastrophic,” she said. Ninety percent of those served at her ADHC have caregivers who work. “It’s short-sighted to throw our seniors and their communities under the bus when they need us most,” she said.

Yamada agreed. “People will have to make a choice between their jobs and taking care of their loved ones, and that is a choice no one should have to make, especially in this economy.”

You can listen to the broadcast later this week when it is posted on at www.kalw.org.

Upcoming Radio Program on ADHC Elimination

We wanted to pass along information on an upcoming program that is of interest to all of us in California, whether your loved one is currently enrolled in Adult Day Health Care or not.

This is from the California Association of Adult Day Services:

Tune in Monday August 8th from 7:00 to 8:00 PM for a live radio program on KALW in the Bay Area on City Visions hosted by Joseph Pace on ADHC elimination.

CAADS member Micheal Pope, Executive Director of Alzheimer's Services of the East Bay, and Elizabeth Zirker, Staff Attorney with Disability Rights California will be interviewed along with Assembly Member Mariko Yamada, Chair of the Assembly Aging and Long Term Care Committee.

The tentative title of the show is "Unkindest Cuts: The Threatened Closure of California's Adult Day Health Centers."

I encourage you to tell friends, colleagues, and interested constituencies about the show and that they are invited to call in or e-mail questions. I am aiming to send you a more detailed description of the show by tomorrow that you may forward.

For your information, the studio call-in line is (415) 841-4134, and comments and questions can be emailed in advance or during the show to feedback@cityvisionsradio.com.

You can listen live on www.kalw.org (click listen live, then click either windows streaming or mp3). You can also listen live at the time
the show airs on cityvisionsradio.com. A day or two after the show there will be a link to listen to the program which in turn you can link to
any other website.

A Massive Grassroots Movement Is Underfoot

Many of you may not be on the San Diego Alzheimer's Association mailing list. But we want to be sure everyone is aware of a movement underway to save adult day health care in California.

Here, in its entirety, is the message that was released. Please, if you know of someone in need or already using these services, consider contributing to the effort to keep many of these 35,000 individuals (not all of whom are elderly or suffering from dementia, by the way) from being placed in more expensive, long-term care facilities or forced into home isolation.

A MASSIVE GRASSROOTS OUTPOURING OF SUPPORT IS NEEDED STARTING TODAY IF WE ARE TO SAVE ADULT DAY HEALTH CARE (ADHC)


Contact Governor Brown's office at (916) 445-2841 and ask him to:

1. Sign AB 96

AB 96 authorizes the state to proceed with submission of a waiver application to Center for Medicaid and Medi-Cal Services (CMS) for a reconfigured ADHC program "Keeping Adults Free from Institutions" (KAFI). The only way to obtain a dollar for dollar federal match of state funding is to get ADHC authorized under a federal waiver.

2. Retain the $85 million appropriation in the budget

This was part of the March compromise to implement KAFI and keep some ADHC infrastructure in place to avoid the greater cost of nursing home admission, emergency room visits and hospital stays for our current ADHC population.

Contact your legislator at (click here to find the phone number for your local legislator) and ask them to:

1. Contact the Governor to:

A. Sign AB 96; and

B. Retain the $85 million appropriation in the budget

Background Information:

The State Senate voted on June 11, 2011 to approve the state budget bill and AB 96 (Blumenfield), which directs the state to apply for a federal waiver for ADHC. The Assembly will vote on AB 96 in the days ahead and is expected to pass. The Legislature must pass a balanced budget bill to the Governor by June 15 or begin forfeiting pay and expenses. It is not balanced until there are enough votes to approve extending the temporary tax measures passed in 2009. Four Republican votes are still needed for any revenue measure. For more information, check out this editorial from the Sacramento Bee outlining the importance of Adult Day Health Centers.

FACTS:

• ADHC is the only community AND medically-based long term support and service.

• The Lewin Group estimated that elimination of ADHC would cost the state $53 million more than it saves.

• In-Home Supportive Services cannot replace the skilled medical services, therapies and social work provided in ADHC.

• The strain on the health care system to absorb 35,000 chronically-ill patients will result in higher medical costs across the system.

Why ADHC Is So Important to Californians

The other week we met a lot of aging Baby Boomers at the Vital Aging Conference in Point Loma. Most thought The George G. Glenner Alzheimer's Family Centers were residential facilities, and when they learned we operated adult day health care centers, they were intrigued. Despite being around for almost 30 years, a lot of people still confuse our services with those of skilled nursing or assisted living facilities.

But we are very different -- and for many families -- very vital to the entire family's well-being. As a day care center, we allow families to continue to all live under one roof. And as a health care center, we continue to monitor and medicate loved ones as needed during daytime hours they are at our centers. This gives caregivers additional peace of mind, knowing their spouse or parent's medical needs are met as well as their emotional, psychological and physical needs while they work or run errands.

As many of our readers know, the state has had to cut back on its support in the past couple of years, and now it is weighing whether to eliminate funding entirely, then restructure ADHC. There's an interesting piece in an online publication produced by The Pew Center for The States on the impact if the state of California pulls funding for Adult Day Health Care Centers.  Consider this passage:

Without Medicaid funding — $170 million from the state, plus an equal amount from the federal government — most of the centers will find it difficult to stay open. The 39,000 elders and adults with disabilities who spend their days at the centers — receiving medical treatment for chronic diseases, as well as mental health counseling and physical therapy — will have to find somewhere else to go.

The state says it will find other Medicaid services for the patients, but elder advocates say there are no other facilities that provide the same kind of care. Many patients will end up calling emergency medical services, going to emergency rooms and getting admitted and re-admitted to hospitals. Some will go directly to nursing homes. Instead of paying $76 per day for adult health care, the state will have to reimburse nursing homes at a rate of $200 per day.

Learn About Important Medi-Cal Changes

People with disabilities and seniors who have Medi-Cal only (not Medicare) are encouraged to come to a free presentation to learn about Medi-Cal changes.

Wednesday, April 27
10 to 11 a.m.
Embassy Suites
601 Pacific Highway, San Diego

RSVP: 1-800-946-4719 or Medi-CalPresentations@berkeley.edu
Please notify Health Care Options by April 22 if you need physical accommodations, ASL interpreters or other assistance.

In 2011 or 2012, you will likely need to enroll in a Medi-Cal Health Plan. Very few people can stay in Regular Medi-Cal. Learn about the various plans and when and how to enroll in one. This program is presented by the California Department of Health Care Services.

Glenner Centers Featured in Modern Healthcare

Everyone's aware that California is in the middle of a fiscal crisis, one that worsens by the week as legislators continually fail to pass a budget now months overdue. This means low-income seniors and their families are quickly losing their safety nets for health care services.

The George G. Glenner Alzheimer's Family Centers was featured in this month's issue to illustrate the extent of the issue and to also discuss low-interest loans being given to facilities that have been hit hard by state cuts and the economy.

Here's just a sample:

For officials at the George G. Glenner Alzheimer's Family Centers, one of eight organizations to receive a no-interest California loan, the delay comes as no surprise after California's repeated failure in recent years to settle up on time. But this year, the suspended Medicaid payments have compounded financial stress from the prolonged economic downturn, says Kelly Focht, the organization's chief executive.

Article: Hanging on in California

A State Plan We Can Live With

Caregivers across California are providing valuable input for a 10-year state plan for Alzheimer’s disease as it continues to be a leading cause of death, a trend likely to continue as baby boomers age.

Last year a 22-member task force was created by appointment, and among those selected was Amy Abrams, a San Diego geriatric care manager who also serves on the Glenner Alzheimer’s Family Centers board of directors. (When we say she’s an active board member, we mean it: Last weekend she ran a marathon to raise funds for our organization.)

Amy is a member of the Health and Medical Subcommittee, which is dedicated to assessing the state’s current health and medical services related to Alzheimer’s and other cognitive impairments.

“It’s been a really interesting process to hear how other professionals are, or would like, to effectively coordinate dementia care,” Amy said in a recent interview. Often, when a family receives a diagnosis of dementia, their primary care doctors do not know what resources are available and how to access them. Her group’s goal is to have every Californian with such a diagnosis be assigned a dementia care coordinator to help connect them with the appropriate services.

Other areas of focus include dealing with a growing shortage of geriatric specialists and working with physicians on continuing education to make sure dementia-specific units are included. “We need primary care physicians to be able to confidently diagnose and follow their patients' dementia,” she said.

We also need family caregivers to give input so the final state plan accurately reflects real-world experiences of those living with Alzheimer’s disease or a related dementia, health and aging leaders throughout California.

An online survey includes questions about the caregiver’s personal experience. It is easy to access via a computer terminal (PC or Apple) and is available in five languages: English, Spanish, Chinese, Vietnamese and Korean. Simply enter the survey address:
http://www.chhs.ca.gov/initiatives/Pages/Alzheimer’sStatePlanDevelopmentTaskForce.aspx or click here.

The survey take less than 5 minutes to complete. To learn more about the survey or the State Plan process, please contact Alex Graves at 916-447-2731 or by email alexgraves@caalz.org.

Don't Let California Eliminate Adult Day Health Care!

There's a way you can help us keep the state of California from eliminating adult health care centers such as those that serve the elderly and their caregivers. And you don't even have to leave home or the office to do it.

Please consider taking the California Budget Challenge. This survey is being used in the budget town halls throughout the state. Right now more than 50% of the people who have logged in have chosen elimination of ADHC. We need to change this with a concerted effort to log in and vote. We need to all log in and get that number down. The elimination of ADHC is an option under the health care section. Please complete the survey and protect ADHC. Many families throughout the state would be severely impacted if it is eliminated, including working-age caregivers who would lose their jobs due to lack of day care.

Once you complete the survey, please forward the following link to the Budget Challenge to your friends and family asking them to do the same.

http://www.nextten.org/next10/programs/budget_challenge.html

On behalf of tends of thousands of families just here in San Diego who are impacted by Alzheimer's disease, THANK YOU!

Help Create A Grand Plan for Alzheimer's

Efforts are underway to create a California State Plan for Alzheimer’s. This collaborative project is being guided by a public-private partnership involving the Alzheimer’s Association’s California Council and the State of California Health and Human Services Agency’s Alzheimer’s Advisory Committee. The purpose is to develop a policy roadmap for the next 10 years to address the growing needs of Californians and their families living with Alzheimer’s.

As part of this process, a number of community meetings are taking place around the state, including one hosted by the San Ysidro Health Center on June 19, which will be focused on Hispanic caregivers. In addition, a statewide online survey for Alzheimer’s family caregivers (former and current) has just been launched.

We encourage everyone reading impacted by Alzheimer's to take the online survey.

For more information, you can visit the San Diego Alzheimer's Association. The deadline for completing the survey is May 31, 2010. Thank you for taking the time to help map our future.

California ADHCs In Jeapordy

As advocates for quality adult day health care, we wanted to draw some attention to Budget Item 4260 currently before California legislators, who are seeking ways to close a huge budget gap. The Governor is proposing to eliminate ADHC facilities statewide to save money. But, in the long run it will cost the state far, far more.

Here’s why:

The loss of more than 7,600 jobs from center personnel layoffs will add $94 million to the state’s Unemployment Insurance Fund. In addition, almost 14,000 working Californians will be forced to quit to care for their loved one, further adding to the loss of income tax revenue.

Thousands more elderly, mentally ill and Alzheimer’s patients will be forced to use already overwhelmed Emergency Rooms and nursing homes for medical crises. This shift to hospitals and nursing homes is conservatively estimated to cost the state $221,400,000 in Medi-Cal State General Fund costs. That almost $89 million more than the Governor’s proposed $134,700,000 General Fund savings from ADHC closures.

California also will lose $216 million in federal matching funds – free money the state an ill afford to turn down.

As the California Association for Adult Day Services notes: “The ‘paper savings’ generated by eliminating all of the state’s 327 Adult Day Health Care facilities will cost more in dollars and lives than it saves.”

CAADS is instead supporting an alternative bill (AB 2073) which would amend eligibility criteria to conform with federal laws and to clarify definitions. This makes criteria legally compliant with federal laws while continuing the state Legislature’s policy of targeting ADHC to the most needy beneficiaries.

You can read a brief history of Adult Day Health Care in California here.

And this editorial on why closing Adult Day Care Health Centers is a bad idea.

Sending a Message to Sacramento

CEO Kelly Focht, M.S.W.
By now, most of us are well aware that the state of California has been hit especially hard by the Great Recession and been forced to severely reduce funding to health and human services, including adult day health care programs and those they serve. Already crippled by cutbacks, these services are again “on the chopping block” as legislative committees begin to look for more ways to close a huge budget deficit.

Glenner Centers’ CEO, Kelly Focht, M.S.W., is one of two advocacy captains in San Diego County working with a statewide organization to convince legislators that an investment in adult health day care services is not only fundamental to saving lives but also to saving the state a great deal of money.

While Glenner Centers are focused on assisting the memory-impaired, it is one of 21 adult day care centers in San Diego and more than 300 throughout California that provide critical services to a much broader group of people with psychiatric, developmental and physical disabilities that require home and community-based services in order to function optimally. Without these services, individuals are at risk of becoming more ill and ending up in emergency rooms and long-term skilled nursing facilities, which average a monthly cost of $4,000 to $6,000 compared to $1,500 to $2,000 for adult day care.

If adult day health care is eliminated as a Medi-Cal benefit, low income, medically at-risk individuals will lose this cost-effective skilled nursing care provided at the adult day health care center. Services include: nursing, mental health services, social work, physical, occupational and speech therapy; medication management; dietary and transportation services. All of these services allow individuals to maintain the life skills required for their own sustainability. Similarly, caregivers who must work to support their families are at risk if their loved one can no longer attend an adult day health care program.

Lawmakers appear to understand the gravity of the issue, as Kelly and other members of the Sacramento-based California Association for Adult Day Services appeal to individual state Senate and Assembly members to not make further cuts in funding.

“I’ve spoken to them on the human costs of further budget reductions,” Kelly said. “We are encouraging our local political leaders to visit our programs so they see firsthand how important these programs are and why they need to stay in place.”

“We need to continue to help those who cannot help themselves,” she added.