GLENDALE (AP) — The grooves in Jose Lanz’s gold college ring have been worn smooth by time, just as age and illness have eroded the 71-year-old Cuban’s mind and body.
Without supervision, he often forgets to swallow his food. He can’t get out of his wheelchair unassisted, and on bad days he reels from drooling laughter to angry outbursts, lost in memories of fights long past.
His wife of nearly half a century is his primary caregiver, but she has relied on publicly funded adult day care during rough patches over the last eight years for help in his care. That benefit could come to an end if proposed budget cuts are carried out to help reverse the state’s $28 billion deficit.
Lanz is one of about 37,000 frail or disabled seniors on Medi-Cal who use adult day health care centers every month, on average. Without funding, the centers are expected to close, meaning that families would have to shoulder the burden of caring for their sick alone or put them in a nursing home, where their care would be more expensive for the state.
According to the National Conference of State Legislatures, in a median year adult day health care services cost $15,600 while a semi-private room in a nursing room costs $67,525.
Like 95 percent of the other seniors at Glendale Gardens, Lanz is dependent on Medi-Cal, the state’s health insurance program for the poor, to pay for the care because he’s deemed medically fragile. Centers like Glendale Gardens provide transportation to and from a facility staffed with medical professionals who help rehabilitate stroke victims, monitor medications for the senile and care for the incontinent.
“Our people come here because they have multiple serious issues, they are people who cannot manage and treat their conditions on their own,” said Armine Oroudjian, a registered nurse and owner of Glendale Gardens, which cares for 75 to 80 seniors a day.
The state program for adult day health care centers is a boon to families, allowing them to leave their loved ones in the care of medical professionals while taking much-needed respite to run errands or go to work.
Lanz’ wife of 46 years, Vilma, says she’s grateful for the help in dealing with his Alzheimer’s disease, Parkinson’s disease, diabetes, high blood pressure, incontinence and emotional mood swings, if only to have some time to buy groceries or clean the house.
Caring for her husband and keeping his spirits up is a full time job, she said.
“I bathe him, I dress him, I cook for him, I check his sugar, I give him his medicine and we watch soap operas,” she said through a translator. “It’s difficult but it’s been 22 years, I’m used to it and I’m a woman of my house. This is my life.”
The $419 million cost of California’s program in fiscal year 2010 was split evenly between state funds and federal matching dollars.
Cuts to care for the vulnerable in Gov. Jerry Brown’s proposed budget don’t end there. The state wants to reduce in-home support services for 440,000 low-income seniors and disabled people, to save $500 million.
The state also is proposing to cap Medi-Cal benefits, such as hearing aids, medical equipment and doctors’ visits. Medi-Cal recipients would be limited to 10 doctors’ visits a year, with a $5 office visit co-pay and a $50 emergency room co-pay.
The state’s director of health care services Toby Douglas said the day care program allows seniors to remain in their communities, but it is optional under Medicaid — known as Medi-Cal in California — and only eight other states pay for the benefit.
“Within the context of the fiscal crisis we’re proposing to eliminate a valuable program,” said Douglas.
In a state Senate hearing last week on cuts to adult day health care and other programs, Sens. Mark De Saulnier, D-Concord, and Elaine Alquist, D-Santa Clara, voiced support for the program but said they are forced to consider cuts because of serious budget problems.
“As a senior, I’m 66 years old now, and in taking care of my late, great husband Al Alquist I administered the medications and gave the showers, I understand what it’s really like,” said Alquist, urging advocates and local officials to help find budget solutions. “There is no long term savings by eliminating (adult day health care), there will be additional costs down the line. There will be great costs.”
Cuts to the program were proposed twice before by former Gov. Arnold Schwarzenegger, but the budget has gone mostly unscathed over the past three years because the Legislature rejected the cuts.
Opponents call cuts short-sighted because their patient conditions will only deteriorate and treatment will become more expensive if they’re neglected.
Last year, a study on behalf of the Congress of California Seniors found that it would cost the state more money to get rid of the program than to keep it, with $51 million in losses in the first year of implementation, and $72 million in the second. The cut would also result in the loss of 7,600 jobs, according to the study by the Lewin Group, a Virginia-based health consulting firm
Douglas’ office said they had not reviewed the study, adding that it’s difficult to project the outcomes the study found.
The cut would force closure of most, if not all, of the state’s 309 adult day health care centers, which are deeply reliant on Medi-Cal funds, said Lydia Missaelides executive director of the trade group California Association for Adult Day Services.
“These seniors are already on Medi-Cal, they have complex medical situations and need skilled nursing and intervention or else their conditions can deteriorate,” said Missaelides.
Center owners say they plan to sue the state for allegedly violating federal disability rights if the cut goes through.
“We’re so small they feel they can touch this and no one will say anything. We’re going to defend ourselves legally because these people deserve it,” said Berdj Karapetian, owner of Victory Adult Day Health Care in Glendale.
Like a revolving door, the program ushers out those who are well enough to leave it and re-enrolls those whose conditions decline by checking to make sure participants medically require the care. The centers provide patient progress reports to the state every three months.
The hardest hit county would be Los Angeles, where the benefit was used 34,246 times in fiscal 2009. That’s nearly 10 times the second-highest number of uses, at 3,472 in San Diego County. In all, the program’s benefits were used more than 53,000 times by programs in 31 counties.
The program is not paid for by private insurance or Medicare, and few families pay for it out of pocket.
At Glendale Gardens, Sourob Megerdichian Sengerdi wears a navy suit jacket and a far-off smile on his face.
Born half-blind in Iran where he was raised by his Armenian family, he took on a line of work that only required him to have one eye open: photographer.
“Weddings, parties, birthdays — I would go to all kinds of parties, take pictures and have a lovely time, so much happiness and joy,” he said in Farsi.
His son Vigen, 50, says that his father was the life of the party until he lost his only good eye two years ago. He has also struggled with his blood pressure, diabetes and weakness in his limbs that has made him clumsy at times.
When he crosses a room at the adult day health care facility, a young nurse guides him in a gentle hug, whispering directions in his ear in Armenian as he takes shuffling half-steps.
“I couldn’t leave him alone,” said Vigen. “I have peace of mind that he is here and I can go to work.”
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