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The human cost of cuts

Occupational therapist Mary Tappan works with Ron Marcia on the range of motion in his hands while Myrtle Higuera does some weight lifting at the Friends House in Santa Rosa. The governor's new budget proposes to eliminate adult day health care. JOHN BURGESS/PD

By GUY KOVNER
THE PRESS DEMOCRAT

Tina Chinn, who gets about with a walker and describes herself as a “bouncing 80,” thrives on her three visits a week to a senior health program at Friends House in Santa Rosa.

“It couldn’t be a better place,” said Chinn, a diminutive gray-haired woman from Windsor who’s quick to smile, despite suffering from diabetes and dementia. “Otherwise, I’d be sitting at home watching the tube or sleeping.”

Chinn, who lives with her daughter’s family, wants no part of a nursing home. “Oh, God, no,” she said. “It’s just not home. It’s terrible.”

But the care and conviviality Chinn enjoys through the Adult Day Health Care program will end if state lawmakers accept Gov. Jerry Brown’s budget proposal to eliminate the $177 million program, which serves 37,000 frail seniors and disabled adults statewide.

With the state facing a $25.4 billion projected budget deficit, Brown is seeking deep cuts in programs that have long been protected by fellow Democrats. He is proposing $12 billion in taxes and fees, which must be approved by voters, and $12.5 billion in spending cuts.

H.D. Palmer, a state Department of Finance spokesman, called the Adult Day Health Care cuts “just one of the very difficult decisions” needed to balance next year’s budget.

Courts have held that the state may not scale back a Medi-Cal program like Adult Day Health Care, but may wipe it out entirely, Palmer said.

Critics of the plan say the savings are an illusion, asserting that closure of the Santa Rosa program and about 310 others statewide would send thousands of low-income elderly and disabled people into nursing homes — at a cost about five times higher.

Medi-Cal costs for a year in adult day health care are about $11,400, compared with $60,000 for a nursing home, officials said.

“This program is a bargain for taxpayers,” said Lydia Missaelides, executive director of the California Association for Adult Day Services. Her organization is gearing up for the third consecutive year to fight the proposed termination.

The Lewin Group, a health services consultant, said last year that shutting down the adult day health program would put 14,000 people into nursing homes at a cost to taxpayers of $93.4 million.

Counting people who transfer to other publicly funded programs, eliminating the adult day health program would shift more than $150 million in new costs to other programs, wiping out the proposed $135 million savings, the Lewin Group forecast last year when Gov. Arnold Schwarzenegger included the plan in his budget.

Lawmakers rejected that proposal, but it resurfaced last week in Brown’s budget, along with two other cuts in services for the elderly and disabled totaling $681 million.

In its response to the budget, the Legislative Analyst’s Office questioned the rationale for eliminating Adult Day Health Care, saying the savings “would be offset by additional costs in Medi-Cal and other state programs.”

Brown’s budget added $16 million to the Developmental Services Department to offset some of the patient transfer from adult day health, Palmer said.

It’s unclear if that’s enough to cover all the cost shifts, said Meredith Wurden, an LAO fiscal and policy analyst. Her office wants the governor to develop “a net savings amount that includes cost shifts to other services,” she said.

Assemblyman Michael Allen, D-Santa Rosa, said he and other lawmakers will ask whether proposed cuts to health services make sense.

“Do they really save money?” he wondered.

Allen, a member of the Assembly Budget Committee, said he hasn’t reached any conclusions yet. “We’re trying to keep an open mind to all the proposals until we understand them.”

State Sen. Noreen Evans, a Santa Rosa Democrat who was highly critical of Schwarzenegger’s proposed budget cuts in 2009 and 2010, did not return telephone calls seeking comment on Brown’s proposal.

In addition to ending Adult Day Health Care, Brown’s budget proposes to eliminate a $19.9 million case management service and to scale back the In-Home Supportive Services Program (IHSS) by $484.6 million.

Susan Beer, a registered nurse who runs the local adult day services program, called the combination “a frontal assault on the elderly.”

Some of her clients, like Paula Vasquez, 71, a former migrant worker who lives in Santa Rosa, use all three of the Medi-Cal funded programs aimed at keeping people out of institutional care.

Vasquez suffers from severe arthritis, hypertension, asthma and diabetes, needs help showering, getting dressed and combing her hair. She wants to remain at home with her husband, who is disabled with diabetes and arthritis, and two grandchildren.

Her daughter and a caregiver paid by IHSS take care of her, and two days a week she rides the adult day health services bus to Friends House.

“I feel better in here,” said Vasquez, who dropped out of school in the fourth grade to care for her siblings and spent her adult life working in the fields of Texas and California. “I never felt as good as I am now.”

Vasquez is striving to walk 75 feet. “I want to get rid of the wheelchair,” she said.

The 45 participants in the program at Friends House, run by Santa Rosa Community Health Centers, range from age 40 to 95. None of them can drive, about half are in wheelchairs and the others need canes or walkers. They need help with daily activities, such as showering, grooming, dressing, eating and using the bathroom.

Some are in pain, some are partially paralyzed by strokes and many are unable to control their bodily functions.

In their four-hour days at Friends House, they receive medical care, speech and physical therapy, help with personal hygiene, lunch and recreation, including card games and exercise.

If the program closed, 11 of her clients would wind up in nursing homes and 18 — no longer under regular nursing supervision — would make more frequent trips to hospital emergency rooms, another cost the governor’s budget does not consider, Beer said.

The Lewin Group, a Virginia-based consultant, said last year that about 36 percent of Adult Day Health Care clients, or about 14,000 people, would initially go to nursing homes. By 2030, the number would swell to 24,500 at a cost to taxpayers of nearly $250 million, Lewin said in a study commissioned by the Congress of California Seniors.

“The human cost is higher, too,” said Diane Kaljian, Sonoma County adult and aging services director. California is “quickly dismantling” the safety net designed to keep elderly and disabled people out of nursing homes.

If the governor’s budget cuts were adopted, many elderly people would fall back on families or fend for themselves, Kaljian said. But some have no relatives nearby, and those left alone often do well temporarily but fall into a state of self-neglect, end up in hospitals and from there go to nursing facilities.

“Home is where most people want to be,” she said.





14 Responses to “The human cost of cuts”

  1. Dr. Dad OCD, ADHD says:

    This is such complete and utter b.s.! The liberals do this every time state or county funds are cut. They use it to hammer on old people and developmentally disabled folks.

    Instead, they can cut all the paid days off each county employee gets, the sick days they all use fraudulently as paid days off, then get rid of all the county paid cars, expense accounts and the assistants to the assistants’ assistants.

    But no, they cut police, firefighters, old people and developmentally disabled folks’ benefits first in order to try to get public support to RAISE TAXES AGAIN rather than cutting back on waste. Liberals are so transparent it’s pathetic. I can’t believe you people keep voting them back into office. You ought to have your heads examined.

    In fact, I’ve got an opening this Thursday at 11am. Call my office.

  2. Raise taxes says:

    Here is the solution. Raise taxes. Simple. Everyone pays more, no one has to cut, everyone is happy, except everyone who pays taxes. Oh well, someone has to pay. I think pensions are protected by law. Some of them anyways. I know mine is hanging in the wind and will probably be confiscated to settle the national debt, oh well. Everyone should put some cash and precious metal under their mattress and not tell anyone. This system will crash, but they will just raise taxes to cover it. Bummer.

  3. Dan Delgado says:

    Brownactjack (or whoeveryou are),
    Evidently you are unaware of adjustments occurring routinely to social security in the form of denied COLAs or pushed back retirement ages.
    As for your other points, it’s possible to confirm whether your telling the truth or making this stuff up since you’re hiding behind a moniker. Accordingly, I give your comment no credence.

  4. brownactjack says:

    to you who wish to lower pension payment, will also want to lower Social Security?
    Oh, and by the way, I was the only speaker who objected to raising the retirement benefits from 2% to 3% when it came before the City Council.
    Where were you?

  5. Jim says:

    @bear

    Your a funny guy, last time I checked the USA was founded in part by tax protest and a huge mis-trust of tyrannical government.

    Can you even name three \degeulatory economic policies\ ? and how have they been corrected?

    I don’t think anybody wants to screw retirees. But politicians made promises to gain constituents that left taxpayers on the hook. Now with everyone bleeding red and leveraged to the hilt, how are the promises going to be paid for?

  6. Dan Delgado says:

    Hey Bear!
    I pay my own mortgage, carry no credit card debt and pay the taxes that support your government pension. You fail to acknowledge thirty (or more) years of union-friendly elected officials that granted you and your cronies those unsustainable and economy-busting pensions. Sure, blame the republicans and everyone else to deflect blame from your public employee union activities that have landed us in the current malaise. But don’t get snarky with me just because I’m tired of paying for it.

  7. bear says:

    What a motley crew of tax protestors.

    You all must love the TV commercials that run nonstop advising you how to get out of credit card and tax debt. Not including fees.

    You are in a recession caused by republican and degeulatory economic policies on the national level. Hey, stock prices are starting to rebound, which will eventually correct the so-called “public pension crisis.”

    Instead of remaining calm, you just want to screw 30-year retirees out of promised benefits?

    Oh, and escape your own mortgages, credit card debt and tax debt at the same time?

    Everybody knows you.

  8. Mike Bonham says:

    “The Human Cost of Cuts.” If government tax cuts and government reductions are not made, the real human cost of cuts is that the economy that continues to tank. Jobs will continue to flee of state to other states and overseas because of the high taxes being leveled against businesses. State and local government regulations which are dicouraging small businesses and driving big business out of the state and Sonoma County will continue.

    Government does not create an economy, it can and is destroying the California economy with taxes and regulations.

    If California and this region are to grow economically, government spending has to be fundamentally reduced.

    Even Governor Brown believes this as he is recommending a sustantial budget cut which is only a beginning of what will have to be done.

    For the forseeable future, government spending as we have known it is over and so are the social and welfare programs, large government pensions and government salaries and benefits. Many are going to be hurt by the reductions. Too many in state government and in city hall still dream of a rescue that is not on the horizon.

  9. Shar says:

    We are going to hear alot of sad and pathetic, tear-jerking stories so J.Brown can set us up for a special election, to raise taxes, for all these underfunded programs.
    The sad part? Most voters will fall for it.
    Many programs/union benefits can be cut before these programs need be affected.

  10. John G. says:

    Personally, I never trust government math for all of the obvious reasons. I would like to see our elders/disabled attended to in the least restrictive and most fiscally responsible manner. Unfortunately the necessary cuts need to come from somewhere. I believe before looking at cuts to the disabled we need to address our illegal immigration/welfare/union pension/tax burdens/environmental regulations that have turned California into a cesspool. Unfortunately with liberals running our state (face it, they have been running CA into the ground for a couple of generations)the disabled our being held hostage once again.

  11. Reality Check says:

    It’s unfortunate the PD never seems to ask the question begging to be asked, why can’t this woman’s family help pay for her 3 days each week at Friends House? No one in her close or extended family can help out?

    Must taxpayers replace the assistance that was once supplied by families? If so, we have a problem beyond solving.

    But maybe Noreen Evans has an even larger problem. After denouncing Schwarzenegger’s proposed cuts in the nastiest of terms, she’s now faced with essentially the same proposal from the leader of her own political party.

  12. Josh Stevens says:

    This state is filled with some of the most economically ignorant voters in the country.

    We could have phased in moderate,responsible cuts years ago.But no,we HAD to spend ourselves into a desperate situation because that’s what “compassion” dictates.

    Now we have no choice.And I pray that when the dummycrats(who spent us into this corner) come crying for a bailout,the Repubs in congress will force them to heal and start budgeting like adults.

  13. Frank says:

    This article is a great example of why we need to be more business friendly, relax the environmental laws governing how to do business in California. The manufacture of goods is much better then the sale of goods because the former does more for revenue for the State. Most may not like it, but, the asphalt gravel, and quarry plants are good for revenue. If we want Solar panels or elec. Cars lets mine the materials needed for these products here in California.
    “The human cost is higher, too said Diane Kaljian, Yes look at the high unemployment, home foreclosures, and a lot of these people do not qualify for a social program.
    I say if we want it lets build it from the ground up

  14. Beef King says:

    There are a lot of sacred cows that need to be disposed of quickly, starting with pension agreements and social entitlements.
    I am skeptical that any of these proposals will see the light of day.
    This talk of budgetary frugalness always seems to go away when the voters get distracted by some other catastrophe.