California budget cuts erase daily lifeline for elderly, disabled people

From The Bay Citizen in California:

The elderly people who gathered for a recent protest at City Hall in San Francisco waved placards and chanted in English and Chinese, “We won’t go to a nursing home!”

Sitting in folding chairs or wheelchairs, surrounded by caregivers and relatives, the protesters cheered speakers who stood at the top of the City Hall steps and railed against the impending closing of adult day health care centers because of the California budget crisis.

More than 150 people, many of them too frail to stand, had gathered to protest the elimination of the centers, which serve about 35,000 elderly and disabled Californians, including 1,500 annually in San Francisco. The rally drew at least four mayoral candidates, including Mayor Ed Lee, who this week proposed to the Board of Supervisors that the city put $3.4 million toward keeping the centers open.

Because of state budget cuts, California’s 274 adult day health care centers, including 10 in San Francisco and 23 more in Bay Area counties, are scheduled to lose their Medi-Cal financing and related federal matching funds at the end of November. One San Francisco center closed earlier this year and another one plans to shut in November.

The centers provide medical and therapeutic care. But they also stand as a bulwark against some of their clients’ greatest fears: being isolated at home by their disabilities or, worse, forced to move into institutions, losing their independence and daily contact with friends and family.

Deundra Hundon of Bayview stood at the top of the City Hall steps during the rally and addressed the crowd. Ms. Hundon’s mother, Sadie Fenley, 77, who has Alzheimer’s, stayed by her side as she spoke.

“If we didn’t have adult day health, can you imagine what her day would be like?” Ms. Hundon said. “Please don’t close adult day health care unless you want people like my mom to be home alone without friends or in a nursing home.”

The centers, located in stand-alone buildings or homes for the elderly, are a medical and social hub for their clients, many of whom have multiple chronic conditions like dementia, diabetes and depression. The programs, which qualified people covered by Medi-Cal attend free of charge, monitor and maintain the clients’ shaky health, helping them to continue to live in their homes, rather than in institutions. In San Francisco, almost half of the clients of the programs live alone.

“This is home away from home,” said Moli Steinert, executive director of SteppingStone, a nonprofit organization that runs four adult day health care centers in San Francisco. Ms. Steinert said that 60 of the 80 people at Golden Gate Adult Day Health Center in the Tenderloin District could end up institutionalized within six months if the center closed.

The state has been paying about $169 million annually to support the adult centers. Norman Williams, a spokesman for the California Department of Health Care Services, said the state would save money by using other means, like managed care plans, to pay for the medical services the centers have provided.

“Our transition plan is designed to provide the types of services that they need to remain independent in the community,” Mr. Williams said.

Still, the state expects that some clients will receive fewer medical services when the centers close, he said.

Disability Rights California, an advocacy group, has filed suit in federal court to try to halt the elimination of Medi-Cal financing for the centers. “If you eliminate this program without providing adequate alternative services that keep people in their own homes, that is a violation of the Americans With Disabilities Act,” said Elizabeth Zirker, a lawyer with Disability Rights California. A federal district court in Oakland will hold a hearing on the case on Nov. 8.

Mr. Williams of the state’s Department of Health Care Services declined to comment on the pending litigation.

At the City Hall demonstration, Leland Yee, a state senator who is running for mayor, chided Gov. Jerry Brown for claiming that alternative services would be found when the centers are shut down. “Guess what? There ain’t no alternative,” Mr. Yee said.

The closing of the adult centers has become an issue in the San Francisco mayoral race. Besides Mr. Yee, several other candidates — Mayor Lee, Supervisor David Chiu and Supervisor John Avalos — spoke out against the closings at the rally.

The financing that Mayor Lee wants the Board of Supervisors to approve could keep some, but not all of the San Francisco centers operating through June, said Anne Hinton, director of the city’s Department of Aging and Adult Services. Ms. Hinton said the city will also petition the federal government for money to keep the centers in operation.

For years, Ms. Hinton said, San Francisco has “actively pursued keeping people out of nursing homes, and day care has been one of the key pieces for them.”

The day health care centers, Ms. Steinert said, helped save the state money, as they kept the elderly and people with disabilities out of expensive nursing homes and hospitals.

Further, many San Francisco nursing homes are at capacity. In September the Golden Gate center had to refer one of its clients to a skilled nursing facility after he fell at home. But no bed could be found in San Francisco, and the client had to be moved to Millbrae.

On a recent Tuesday at the Golden Gate center, Canhua Guan sat in his wheelchair in a bright, airy room, surrounded by other elderly San Franciscans. As a Chinese music video played on a TV, Mr. Guan, 87, manipulated colorful wooden pegs into a pegboard.

Mr. Guan, who has diabetes, depression and severe dementia, spends more than five hours every weekday at the center. He lives in the Mission District with Qiu Xing Guo, 81, his wife of 62 years.

At the center, health care workers monitor Mr. Guan’s vital signs and administer physical and occupational therapy to strengthen the muscles in his shoulders and legs. At home, he had fallen several times.

Ms. Guo, who spoke for Mr. Guan, who is often confused, said her husband was very happy going to the center and did not want to go to live in a nursing home. At the center, staff said, he is known for doing tai chi in his wheelchair and making jokes.

Ms. Guo, who has chronic back pain, high blood pressure and vertigo, said that if the center closed, she would have a hard time meeting her husband’s needs at home, even with the help of their son and daughter.

She added that when her husband was at Golden Gate, it allowed a break from her constant caregiving duties, giving her time to meet with friends and walk and shop in Chinatown.

“If the center closes, it will cause me, my son and daughter a lot of problems,” Ms. Guo said, through an interpreter.