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Brown defends veto of adult day healthcare legislation

Photo: California Gov. Jerry Brown. Credit: Robert Gauthier / Los Angeles Times Gov. Jerry Brown on Tuesday defended his veto of legislation that would have provided a replacement for an adult day healthcare program cut in the latest state budget, saying that alternative services would be found for about 35,000 medically frail or disabled participants.

Brown’s veto message Monday said the benefit would be available to Medi-Cal recipients until Dec. 1, allowing enough time for a smooth transition to in-home care or other community-based support services. It also directed the Department of Health Care Services to ensure that "those who are most at risk of institutionalization have access to services that will help them remain in the community."

But center operators said that for many of their low-income participants -- who suffer from brain injuries, dementia and other chronic conditions -- there are no other appropriate alternatives.

They estimated that nearly a quarter would end up in a nursing facility within 30 days of losing daycare services, according to a survey conducted last month by the California Assn. for Adult Day Services. And they estimated that within 90 days, as many as 87% would need emergency room care for preventable falls, medication mismanagement and other complications.

That would wipe out any savings from eliminating the program, said Lydia Missaelides, the association’s executive director.

Brown disagreed, telling reporters in San Francisco that adult daycare services will remain an option for Medi-Cal recipients, but one provided through managed care programs.

"The principle here is that California does not have enough money to do all the things it has been doing," Brown said. But he added: "We’re looking at each of these individual people, their cases, and we’re going to handle them in the most humane way we can."

Brown signed a separate bill Monday that will allow the more than 300 adult daycare centers in California to continue operating without Medi-Cal licensing for participants who pay for their own care or are covered by private insurance.

But Missaelides said most of those who attend are covered by Medi-Cal, and 95% of the centers would close within two months without their participation. At least 17 centers already have announced that they are closing because of funding uncertainties, including one operated by the Institute on Aging in San Francisco.

Program director Tracy McCloud told reporters on a conference call Tuesday that the center has struggled to find placements for the 72 Medi-Cal beneficiaries in the program. Some did not meet eligibility requirements for other programs and others could not find the services they needed.

"Against our advice, many enrolled in other adult day health centers," which also could now close, McCloud said. "I’m not sure what’s going to happen to those people at this point."

Nina Nolcox, who administers Graceful Senescence Adult Day Health Care in South Los Angeles, said programs that provide in-home care and other community-based support have also been subject to budget cuts in recent years.

"What we found is really long waiting times," she said.

Even if the state puts more money into such alternatives, she said, they do not offer the combination of medical and social services available at adult day healthcare centers.

For Robert Williams, 51, that combination of services has been invaluable. He moved across the country to care for his 81-year-old sister, Shirley, when Nolcox’s center alerted him that her memory had deteriorated to the point where she should not be living alone.

"She loves going to the daycare center," he said. "She has camaraderie, they keep her active, they exercise.... It gives her a reason to get up every day."

It took Williams nine months to find a job with a security company. Now he’s afraid he might have to quit if he can’t find another program for her.

"My sister is just one of thousands of people who need these services," he said. "And for them to be taken away is really a grave injustice."

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-- Alexandra Zavis in Los Angeles and Maria LaGanga in San Francisco

Photo: California Gov. Jerry Brown. Credit: Robert Gauthier / Los Angeles Times

 
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