Nursing Home Nightmares Recur As California Enables More Customers


assemblymember-mariko-yamada35,000 poor, frail elders slated to lose adult daycare benefit December 1

By Assemblymember Mariko Yamada

Recent front-page Sacramento Bee headlines about tragedies in California nursing homes should be glaring reminders about the reasons California pioneered the Adult Day Health Care (ADHC) alternative to nursing home care forty years ago.   If you are old, or are planning to be – pay attention – because this system is about to vanish.

Facing severe budget pressures, the Department of Health Care Services (DHCS) is currently dismantling the ADHC program in California.  This proven cost-effective program that has worked well to keep Californians out of nursing homes for the past four decades has fallen victim to an annual game of “budget chicken”.

How did this happen?

In response to well-documented stories of institutional abuse in long-term care facilities in the 1980’s, California pioneered Adult Day Health Care, a community-based, integrated health and social services program designed to keep frail and disabled persons out of nursing homes.  Since that time, the  ADHC daytime congregate care program has saved the state hundreds of millions in nursing home and emergency services costs by providing frail seniors with multiple complex medical conditions a safe daily care setting.

Over the past several years, California’s continuing fiscal woes have seen Republican and Democratic Governors alike cutting this MediCal “optional” program.  Each time, advocates sued, with the courts blocking the cuts.  In fact, a suit to block the elimination of ADHC is pending now.

Governor Jerry Brown proposed the elimination of the ADHC program in his 2011-2012 budget.  Without support for revenue extensions, all Assembly Democrats voted for the Governor’s proposal, with the understanding that AB 96, legislation that provided for a “step-down” alternative ADHC program would take its place. This new program, “Keeping Adults Free of Institutions” – or KAFI – was budgeted at $85 million, half of the current cost of ADHC.

The Governor vetoed AB 96 unexpectedly at the end of July, throwing the ADHC community into confusion and chaos.  With a looming deadline of December 1 for program elimination, DHCS has started to shift ADHC recipients to Medi-Cal managed care and is contracting with out-of-state corporations to provide less reliable and more costly services.

On August 16, I convened an oversight hearing of the Assembly Aging and Long-Term Care Committee on the costs and consequences of the AB 96 veto. The Senate Budget Subcommittee on Health and Human Services held a similar hearing on September 2.  DHCS continues to put a “happy face” on the transition plan.  However, the community isn’t smiling.

Thirty-seven of my colleagues, including 35 Assemblymembers and 2 State Senators, sent a letter to DHCS Director Toby Douglas on August 24, asking specific questions about how DHCS will accomplish this massive shift in health and social service delivery in so little time, and requested a delay in the elimination of ADHC until legislative committees could review the plan and evaluate nursing home capacity. Just like the transition plan, the answers to our questions have been vague and open-ended.

Now, tens of thousands of ADHC clients – mainly poor, elderly women -along with their families and the 7,000 workers who care for them are slated to be cut from their programs and lose their jobs.  Of the 330 ADHCs in California, 21 have already closed, and it is unclear where their former clients have gone, because no one is tracking them.  There is no doubt that the destruction of the ADHC program will result in increased 911 calls, hospital emergency room visits, nursing home placements, and investigations for abuse and neglect.  Demands for mental health care, and in-home supportive services will also rise-at a time when budgets for all of these programs are being slashed.  Without safe adult daycare, working family members will either have to quit their jobs to care for their loved ones or place their family members in less appropriate settings-often, nursing homes.

Both Governor Brown and I are senior citizens.  My hope is that you will become one, too.

With an exploding population of baby boomers, persons with autism and Alzheimer’s, returning veterans with disabling conditions and traumatic brain injuries, along with increasing numbers of  impoverished adults with multiple chronic conditions in our communities, is this the time to take a wrecking-ball to a proven, cost-effective program serving our State’s most vulnerable?  Will the courts again provide relief at the expected November 8 hearing, three weeks before the December 1 elimination date?

History will be the judge of my vote and the Governor’s veto.  But unless we raise our voices now, we will all surely suffer the consequences.

Mariko Yamada represents the 8th Assembly District and is Chair of the Assembly Committee on Aging and Long-Term Care.  She now regrets her vote to support Governor Brown’s ADHC elimination proposal and authored the legislative letter to DHCS asking to delay the closure. 


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13 thoughts on “Nursing Home Nightmares Recur As California Enables More Customers”

  1. E Roberts Musser

    I would like to also point out that a frail elder, who is moved away from a home setting with assistance from programs like Adult Day Health – into a nursing home setting – very often die from the trauma of the move. At our Yolo County Multi-Disciplinary Team meetings, we have discussed grim cases like this. Is this the state’s purpose? To rid itself of citizens it believes no longer have value to society? What if it was their mother or father at home and enrolled in Adult Day Health, suddenly moved into a more costly institutional setting, that killed them in the process of transition to a place they don’t want to go?

  2. E Roberts Musser

    [quote]What is the difference between ADHC and IHSS?[/quote]

    ADHC – Adult Day Health Care – is a center where those who have serious disabilities can reside in daylight hours, while family members are at work during weekdays. Depending on the degree of the disability, the disabled person is permitted to come to an Adult Day Health Center one, two, three, four or five days of the week. In the case of Yolo Adult Day Health, a bus with door to door service is provided. Those disabled who are low income can pay for their time at the Center through Medicaid (in CA it is MediCal). Those with more income are private pay clients. An example of a disabled person who might qualify for ADHC is someone with Alzheimer’s Disease. Family members can continue to work, while their disabled loved one is cared for at the Center. In the evenings and on weekends, the disabled person would be cared for by the family members at home. Without Adult Day Health Care, the disabled person would be institutionalized in a nursing home setting.

    IHSS – In Home Supportive Care – those income qualified disabled persons living independently are entitled to a certain number of hours of caregiving services (IHSS) to assist them with the activities of daily living (e.g. grocery shopping, cleaning, bathing). The caregivers are paid by the gov’t. Again, IHSS keeps the disabled out of institutions and living at home.

    Both IHSS and ADHC are a cheaper and more humane alternative to institutionalization, which the state just does not seem to get, for whatever reason. I have heard that some ADHC’s are less than stellar, but that is no reason to chuck the baby out with the bath water. Shut down those that are abusing the privilege, but save those doing an excellent job – like Yolo Adult Day Health.

  3. Rifkin

    Thanks, Elaine.

    What would make sense to me for supporters of these sorts of programs would be to identify revenues which are now going somewhere else and say, “this is more important. Fund ADHC or IHSS.” Not having given it much thought, I think Mariko and her allies should call for taking funds from all state retirees who are under 65 and fully able-bodied and able-minded which are now going to pay for their retiree medical care. I would suspect that amount saved would be more than enough to fund ADHC and IHSS.

    Those young retirees — a good share of whom are retired 50 to 55 year old former CHPs and Prison Guards and administrators in public safety — generally make a good pension and can either continue on their jobs or pay for their medical care out of their lush pensions.

  4. Michael Harrington

    Mariko, a few years ago I represented a number of employees of senior nursing homes throughout California, and sued the owners for labor law violations.

    (I know, it’s not aviation or marine, but some vulnerable employees came to me and I was completely disgusted at what I saw.)

    I found horrible conditions for the employees, but even more importantly, for the frail elderly who live in these 6 or less patient homes. Some of those homes have the day care program to add to the daytime population, and profits.

    I bankrupted a number of homes and the owners, but the state regulators ignored my evidence and the abusers got off scott free, other than I forced them into Chapter 7 and they last about 12 homes amongst the groups.

    I know for a fact that some of the state regulators live in Davis.

    If anyone wants to see my files and is in a position to do something about the system flows, I have them and you are welcome to come over and I will take time to brief you and show you the key evidence.

  5. E Roberts Musser

    To Rich Rifkin: Your welcome! What makes no sense to me is that these programs actually save the state money in the long run, IF THE STATE WERE BEING HONEST ABOUT IT. But somehow the politicians use creative bookkeeping to convince themselves cutting these programs will “save” money! But what is really going on and frightening is that there will be nowhere for these disabled people to even be institutionalized. There are only so many skilled nursing home beds, and no more. So where do these disabled people go when all the skilled nursing beds are quickly filled? Left homeless to shift for themselves? Or family members must quit a job to stay home and take care of a loved one with dementia? What if they cannot make their mortgage payments as a result. They all end up out on the street? The state has neglected to answer these questions, much as it has not really answered many questions about realignment of prison services to the counties. The Governor/some legislators have just made slashes on the budget line, and d_mn the consequences.

  6. E Roberts Musser

    [quote]I found horrible conditions for the employees, but even more importantly, for the frail elderly who live in these 6 or less patient homes.[/quote]

    Are you talking about skilled nursing facilities, or board and cares? There is a difference…

  7. Frankly

    We need to take care of elderly that do not have means to take care of themselves.

    We need to take care of children making sure they are as safe and as cared for as possible while we educate them as well we possibly can to give them the best possible chance toward happiness and prosperity.

    We need to care for the truly sick and disabled.

    The rest receiving entitlements are exploiting and raping the system and depleting it of the funds necessary to do the right things. Also, they are served by too many government agencies and public employees that also deplete the fund necessary to do the right things.

    Politicians cut these types of programs because the beneficiaries have no political power. These politicians screw the powerless so they don’t have to disappoint the unions that fill their campaign coffers. These politicians are valuing a 3 by 50 pension for overpriced prison guards over needy elderly. These politicians depend on the media, union advertising campaigns and political activists to create the smokescreen of deflected blame and emotional outrage that they hope will result in higher and higher taxes. It is a game they have won before and they are addicted to it. The problem is that they are ignoring the message from voters that enough is enough… no more tax increases. We have to cut. But what we want them to cut is the fat of government… including the army of public sector employees, their compensation levels and their gravy train pensions and free healthcare for life. What we DON’T want them to cut are services for the truly needy.

    The solution to the problem is to consider who you vote for. Consider which groups these politicians are beholden too and then look at yourself in the mirror as the potential reason we cut teachers, and programs for the elderly.

  8. E Roberts Musser

    [quote]Politicians cut these types of programs because the beneficiaries have no political power. [/quote]

    Jeff, you hit the nail right on the head with this statement!

  9. medwoman


    Ii understand your point about cutting benefits to beneficiaries who have no political power. The part of your argument with w
    Which I have difficulty is “The rest receiving entitlements are exploiting and raping the system and depleting it of the funds necessary to do the right things.”
    This is a very broad and general statement. I would be interested in knowing just who you think these unworthy recipients are, how many you think there are, how much you believe they are costing the city, or county, or state or country depending on how you want to count it, and what your sources are for your beliefs.

    Also, I agree with you that it is important to consider the perspective of those for whom we vote. Just as important as “who they are beholding to” is what is their world view based on ? Are they someone who truly believes in equality of opportunity of the individual, or are they someone who only believes in corporate opportunity, as one example. Are they someone who only understands the downside of” too much government intervention ” whatever they perceive that to be, or are they someone who also understands the adverse consequences of the extreme disparities in wealth that we are currently seeing ? Do they believe that our problems are based on “too much spending”, ” too little revenue” ?
    Or do they have have a more nuanced position that both may be contributing depending on one’s perspective and specific community needs? There is much to consider when choosing our elected officials.

  10. Frankly

    Medwoman: I know and know of far too many people on public assistance that should not be, but that justify it. Humans are almost infinitely and progressively trainable/moldable. That is our advantage, and our liability at the same time depending on what we are trained/molded to think and do. We naturally want to progress to the next level. We fill our tank with something and then reset our expectations to look for the next better thing. Unlike the gorillas in the mist, we are not made happy be just existing in our same state forever. Our challenge is to not let our need to progress paint us into a corner.

    Think about all the people working in Chinese factories. I would imagine that you conjer a story of this situation that pulls at your heart strings and would motivate you to opinion or action to stop the “abuses” as you see them. The problem with this approach is that “abuse” continues to be redefined as that next step of progress. Marching through time eventually an employee can claim abuse when a boss gives them an unfriendly look (“unfriendly” being defined within a 17-ton pile of paper that comprises the federal register of laws and regulations.)

    The fact is that there are many Americans that should be working in Chinese factories. However, we take care of them. They have progressed in seeking steps toward prosperity on a path that has them trapped. They are moochers and then are forever locked into their situation with help from the looters that want to “care” for them.

    What they really need to allow them to escape their dead-end life, is a sort of producer boot camp. It is all tough-love. For example, people with a disability that keeps them from working when the disability is that they live with some joint pain. How many Chinese workers do you think complain about pain from repetitive stress syndrome? How much pain did workers deal with before we had such generous disability laws? How many people chose welfare and food stamps before these things were so widely available?

    We cannot afford the low bar we set for disabled or needy. Time to toughen up… pull up our bootstraps and get back to work. Regular exercise, a good diet, and Advil… plus a mindset that a person has to work to survive… Caring for yourself is not a tragedy, it is a requirement.

  11. Chantelle

    The taking away of care for the elderly and disabled remind me of Hitler.
    The difference?
    His removal of select unwanted was euthanasia
    the republican pull of care is dissanthanasia
    The goal it seems to me, is the same.

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