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.