California cuts undermine health reform initiatives

Los Angeles, Ca.- At any given moment, seniors at Grace Adult Day Health Care Center in Sunnyvale may be exercising on stationary bikes, gabbing over lunch, playing word games or bending over an intense chess match.

This day care center for the old and infirm is the kind of place that health care experts say is critical to keeping the elderly in their communities and out of costly nursing homes.

Yet with state lawmakers slashing funding for such centers’ programs by more than half, co-owners Manooch and Suzanne Pouransari are now facing the prospect of closing their doors.

And the ultimate irony? The Pouransaris are considering opening a nursing home.

A collision is under way between federal health initiatives and state budget cuts. Even as the federal government devotes vast sums to keeping people out of institutional care, state spending reductions are trimming many programs that support non-institutional care.

In Santa Clara and other California counties, the federal government is spending $10 billion over five years to expand public health programs to uninsured residents in advance of 2014, when major provisions of the national health care overhaul kick in. This “Bridge to Reform” directs participating counties to better manage chronic diseases before patients land in emergency rooms.

But those efforts are undermined by state cuts to the very community-based programs which do just that.

“The bizarre disconnect is that we know that home-based care is the answer,” said Cheryl Phillips, outgoing chief medical officer of On Lok, a long-time provider of community-based long-term care in the Bay Area. “But in our (budget) crisis, we can’t seem to have the short-term dollars to pay for the long-term solution.” The Pouransaris’ preference is to keep their center open, but they may have no choice.

“Even if we put just 50 people in a nursing home,” said Suzanne Pouransari, “it will cost the state more than keeping the whole (adult day health care) center open.”

On a typical day, about 135 people attend Grace. All are on Medi-Cal, the state’s Medicaid health insurance program for low-income residents, meaning the center is entirely dependent on government funding.

At least one-third have Alzheimer’s disease or dementia and the rest have a variety of chronic conditions, including hypertension, diabetes and arthritis, said Manooch Pouransari.

The center offers medical services, physical and speech therapy, meals and social stimulation. Vans pick up participants at their homes in the morning and take them back in the afternoon.

One participant is Estela Diaz, 70, who has diabetes and dementia, and has been coming to Grace for two years. Not long ago she ate some sugary treats from a care package meant for her granddaughters.

“She forgets she can’t have candy,” said daughter Ida Pritchard, 41, of San Jose.

When a nurse at Grace checked Diaz’s blood sugar, it registered at a whopping 545, at least four times the normal level. Pritchard’s husband, David, sped over and took Diaz to the emergency room. Of Grace, he said, “You know she’s taken care of.”

If the center closes, some participants will go to nursing homes and some family members may leave their jobs to care for loved ones.

“I don’t know how it’s going to work out,” said Suzanne Pouransari. “It’s going to be chaos.” Grace is among 310 centers statewide that serve about 38,500 people, according to the Department of Health Care Services. Medi-Cal pays $76.27 per day for Adult Day Health Care, compared to the average daily rate for nursing homes of $173.34. Medi-Cal participants don’t pay out of pocket for either service.

Adult day health care programs are optional Medicaid benefits that can be trimmed; nursing homes are mandatory and cannot be cut.

“Is it something legislators want to do? Of course not,” said Matt Salo, executive director of the National Association of Medicaid Directors. “But we’ve come to the end of our calculation here. There’s really just no other option.”

This story was printed by California HealthCare Foundation

By Emily Bazar, CHCF Center for Health Reporting



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