Frances Jones, left; Natalie Frank, staff activities assistant; and Erma Westover at Acacia Adult Day Services in Garden Grove. (Photo by: Kenny Rivera) Credit: Kenny Rivera

Wednesday, January 19, 2011 | California is home to 37,000 adults, including the elderly and those who suffer from severe disabilities, who cannot take care of themselves and don’t have someone to care for them during the day.

And for the third time in two years, the fates of these vulnerable Californians hang in the balance as another governor targets the state-funded program that helps them.

Most of the roughly 300 adult day care centers throughout the state — including about 20 in Orange County that serve 2,000 people — will likely close if cuts proposed by Gov. Jerry Brown to shrink a $25.4 billion budget deficit become a reality, said Lydia Missaelides, executive director of the California Association of Adult Day Services.

The state Department of Finance estimates about $176 million would be saved in the fiscal year beginning July 1 if California stopped providing Medi-Cal payments to support the Adult Day Health Care program.

“We’re going to fight this elimination proposal with everything that anyone has,” Missaelides said in a telephone interview. “This is not a logical choice for the governor, the Legislature and everyone to make.”

Facing the brunt of this choice are the people like those served by Acacia Adult Day Services in Garden Grove — people who rely on the center to, among other things, give them their medications on time, rehab them from strokes or treat their dementia.

Although the majority of those at Acacia are seniors, the program cares for adults of all ages who qualify for the low-income state Medi-Cal programs.

Without the program, a family member may have to quit work to care for them at home and others may wind up in government-subsidized homes that cost more than the day care, said Mallory Vega, executive director of Acacia.

In addition, programs like the Alzheimer’s Association and the county’s Adult Protective Services rely on places like Acacia for their clients as a less expensive alternative to care homes, Vega said.

A Long History

Acacia began in 1979 and was housed for years at the local Methodist Church. In the late 1990s, when the new Garden Grove City Hall was built, a spacious, brightly lit new home for Acacia was erected on the grounds of the old hall.

It now serves between 75 and 80 adults who will spend the day getting physical or speech therapy, receiving medical treatments, socializing, eating lunch, attending exercise classes or working on brain improvement and other programs. The center has a staff of 32 that includes nurses, social workers and physical therapy volunteers, said program director Julie Duarte.

Eliminating the Medi-Cal payments would have a devastating impact, Vega said.

“The likelihood would be that we would close,” she said. “We would fight before we would go down, but it would decimate the program. I guess the hardest thing is to say the truth like that and have it in the news … but it’s the truth.”

And, she said, even if state officials said they would restart the program in a few years when the economy improves, it would take years to re-establish the quality of what currently exists because employees, and with them institutional knowledge, would scatter, and it isn’t a program that can just be reopened quickly.

Missaelides notes that twice since 2009 they convinced lawmakers to keep the program after former Gov. Arnold Schwarzenegger proposed closing it.

A Day in the Life

When it’s time for group exercise at Acacia, a video is inserted into the TV featuring a workout for those using metal walkers. Except for two men working on a brain enhancing exercise, everyone at the center joins the exercise program, even those who stretch and bend while sitting down.

Books on the library shelves are divided by category, like mystery or reference, and by language — English, Vietnamese, Korean and Spanish. The population of those using the center is 53 percent Asian, 16 percent Latino, 29 percent non-Latino White and 2 percent African American.

“The majority of our staff are bilingual,” Duarte said.

It costs between $85 and $100 a day per person to run the program, said Duarte. Medi-Cal picks up about $76 of the cost, with roughly $38 coming from state funds and a similar amount from the federal government.

Missaelides said centers around the state rely on their own fundraising efforts to make up the difference between what Medi-Cal pays and the actual cost.

Dire Consequences

If the programs are closed down, those in adult healthcare can’t automatically go into nursing homes, said Deborah Pacyna, spokeswoman for the California Association of Health Facilities, because those spaces are reserved for “people who are very sick.”

The concern, said Vega, Duarte and others, is that without the program, some patients may be left home alone during the day and not take medications on time or eat properly and wind up in emergency rooms, where the cost of the care could be more than staying in the day centers.

“Somebody’s going to have to step in with some new program,” said Pacyna, “especially for dementia [patients]. But nobody knows who’s going to do it.”

Missaelides said the adult day healthcare association is contacting supporters throughout the state and urging them to talk to their legislators about blocking the planned cuts.

Brown proposed ending the day care and many other programs to offset a $25.4 billion state budget deficit. Part of that plan includes extending $9 billion in temporary sales and income and vehicle tax increases.

The voters must approve the tax extensions, and Brown is expected to ask the state Legislature for a special election in June. But even with the continuation of the tax increases, the budget deficit is so huge that proposed budget cuts, including that for adult day healthcare, would stand.

If lawmakers refuse to set the special election or voters reject a continuation of the taxes, local health, social service and other cuts could go even deeper. Brown has declined to specify what further cuts he would make if his plan fails in the Legislature or voters refuse to extend the tax increases.

Families of those in the program and those who come to the day care “once again are being scared to death,” Missaelides said. But “it’s not a fait accompli. This is just the beginning.”

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