When California halts Medi-Cal reimbursements for adult day health programs across the state, as the Department of Health Care Services eventually plans to do, Rose Kleiner will no longer be able to afford to provide free care to the 32 low-income seniors who regularly attend the center.
Though Rose Kleiner will remain open for families who can afford to pay, officials at the center and Medi-Cal recipients who rely on the free care they receive there said the state should look to make cuts elsewhere.
Right now, Medi-Cal, California's Medicaid program, pays more than half the cost associated with a day at Rose Kleiner — about $76. The center makes up the difference through its fundraising efforts, making it possible for patients like Grace Archibong to attend.
Archibong, who is recovering from a stroke and a knee replacement, said that Rose Kleiner has been instrumental in her recovery. "This place not only accelerated my health progress, but I very much enjoy the community," she said.
If it weren't for the center, Archibong said she would spend most of her days by herself at home, as her husband spends most of his days working on the family business. "Here, I'm not alone."
State budget crisis
However, with California in the midst of a financial crisis, the Department of Health Care Services plans to eliminate adult day care as a Medi-Cal benefit. And while the cut is projected to save the state $169 million, it would force many like Archibong out of centers like Rose Kleiner.
"It's a very difficult decision, but California is facing a very serious budget deficit," said Norman Williams, deputy director of the department. Because Medi-Cal is the state's second largest general fund expenditure, "for any budget solution, Medi-Cal must be a part of that solution."
Williams said that adult day health care is an "optional" Medi-Cal program, meaning that unlike trips to a primary care physician or prescription medication payments, which the federal government requires states to cover with their Medicaid dollars, California is not required to cover the services provided by centers like Rose Kleiner.
Lenny Park, director of the Rose Kleiner Senior Day Health Center, does not think of the programs she oversees as "optional."
"These people need to be monitored," Park said. Some of the seniors at Rose Kleiner are immobile, due to an injury or health condition, others have dementia and have been known to wander off. On-site nurses administer medications and monitor the health of the seniors. Dieticians make sure the men and women stick to any special nutritional regimens and aides plan activities that are both mentally stimulating and entertaining.
While medicine can be administered and strict diets can be followed from home, the social dynamic of places like the Rose Kleiner center is vital to keeping seniors healthy, Park said. Seniors at Rose Kleiner can play games, take exercise classes and socialize with their peers in a safe environment.
"Depression is a big problem with elderly people," she said, explaining that for too many seniors, "the television set becomes the babysitter."
Rose Kleiner also plays a role in ensuring that entire families continue to function. Taking care of a frail parent or grandparent can be a full-time job, Park said.
"There are definitely some families right now that will have to choose between working and taking care of their parents," said Joan O'Keef, the head nurse at Rose Kleiner.
Mike Atkin's wife, who suffers from depression and bipolar disorder, attends the center five days a week. "If she didn't have this place, she'd just sit at home, staring," Atkin said.
Atkin said he appreciates Rose Kleiner, as it allows him to spend his weekdays with friends, visiting with family or taking care of the household — all things that would be challenging to accomplish if he had to keep an eye on his wife all day.
He views the services as a win-win and said that his adult children feel the same way. "She's in good hands and occupied," he said of his wife, "and they appreciate that I get a life."
Atkin won't be impacted by the state's cuts, as he and his wife don't rely on Medi-Cal — a service for low-income people. But for those who will be pushed out of centers like Rose Kleiner, "it's a major calamity," he said.
At the moment, the officials at Rose Kleiner are not entirely sure what the future holds. The Medi-Cal reimbursements for adult day care were initially supposed to end Sept. 1. However, Toby Douglas, director of the Department of Health Care Services, told adult day care centers that the benefit will be extended on a month-to-month basis, so that the state can ensure that seniors dependent on the service are transitioned smoothly into another care option.
Williams said that the state will do its best to ensure that all patient needs are met, while simultaneously making sure that care is delivered in a more efficient manner.
Park is skeptical that the state will be able to accomplish this goal. In fact, she said, it is likely that more people will end up in nursing homes, which cost about $40 more per day than the service Rose Kleiner offers. That cost will ultimately be passed on to taxpayers, she reasoned, as the federal government will be obligated to pay for the treatment of those individuals.
In the event that the Medi-Cal reimbursement for adult day care is cut, Rose Kleiner will remain open but it will have to eliminate some staff, Park said. Other similar centers around the state won't be able to remain open, and 10 adult day care facilities have already closed in California.
State Democrats opposed to the elimination of the Medi-Cal benefit have drafted a bill, AB96, that aims to shrink the number of Medi-Cal reimbursements made for adult day care by limiting such payments to only the neediest of patients.
AB96 is a step in the right direction, said Lisa Hendrickson, president and CEO of Avenidas, the organization that runs the Rose Kleiner center. AB96 is "very important, because it would put us on a path to another medical benefit for adult day care, but it's not enough."
Hendrickson and Park said it is clear that the cuts to Medi-Cal are inevitable. Their hope is that the state will give their Medi-Cal patients and their families enough time to find alternative care.
Until then, Park said, "the important thing from our point of view is to continue giving services to people, whether they have Medi-Cal or not."