Monday, July 9, 2012
Adult day health care in California is feeling the pinch of the state’s budget crisis. The state has been working to scale back the publicly-funded program that helps elderly and fragile adults.
Every weekday at Altamedix adult day health center in North Sacramento, over a hundred Russian speaking immigrants follow a tight schedule of health education and exercise. Mikhail Borisov is the lead social worker at Altamedix. He said the people here get this state-funded service because their health is at risk. Almost all of them are elderly.
"Many of them need supervision, things like bathing, dressing, they aren't able to access resources by themselves without assistance," said Borisov.
Some of the eastern Europeans here came as refugees after the fall of the Soviet Union. Their medication is managed and their therapy individualized. But Borisov said that's not all they get, because "for many of them, this is everything. This is the only contact with the outside world that they get."
When a legal settlement restored adult day health in the state budget last year, the new program was reserved only for the frailest. In recent months, state-employed nurses have been visiting the centers to determine which participants are needy enough to keep getting the service.
"It is difficult, but it’s better than the worst-case scenario," commented Altamedix’s director, Sergey Ionov. He said twenty-eight participants have been deemed ineligible for service. They appealed and hope to win back the right to stay. The center isn’t being paid while they wait for their appeal hearings. Ionov explained that "a lot of these people have attended our program for years and they need the services. They have little or no alternatives."
The state is also backlogged on paperwork that allows Altamedix to be paid for other participants. Ionov said more than forty percent of the cases here are currently unbillable, and he keeps the doors open with a line of credit. "The main thing is that our participants keep getting services," he said. "That’s the main thing."
At over 260 centers like this around the state, the cashflow situation is what Lydia Missaelides would call “dire.” She’s with the California Association of Adult Day Services or CAADS.
"Some centers have already reduced hours of operation, some have already reduced their staff, laid off some staff," said Missaelides. "Some are preparing plans for temporarily closing. Others are having a very difficult time finding lines of credit."
CAADS surveyed its centers. Those that responded said if the state reimbursements don't start coming in soon, they would have to close, lay off staff, or stop serving the participants who have been judged ineligible. Missaelides commented "it’s the worst I’ve seen in all of my years of working in this field, and I am trying to stay optimistic."
The California Department of Health Care Services said about 1,800 people have been found ineligible and have asked for an appeal, and about 200 nurses are working on the entire transition. John Shen is the State’s director of Long Term Care.
"So we’re behind and we try to catch up, just because of the volume of the work that we have to deal with,” explained Shen. He also said they're hoping the hearings go more quickly when they’ve ironed out the system.
"This has been a long, hard process for the department as well as for the provider as well as for the consumer, not knowing what happened to them, but we are really at the end of it so to speak, at the end of the tunnel."
But for many participants, hearings could be months away, and for the centers, the transition is far from over. In the meantime, Altamedix continues to serve the twenty-eight ineligibles without reimbursement.
The old and fragile adults are known to break out in traditional church song during monotonous exercise. They may not fully understand the complexity of the situation, but they fear they may not be coming here for much longer.