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In July 2020, Cole Cross packed up her home, left her career behind, took her two cats and two dogs, and moved in with her grandmother, becoming a full-time caretaker.
This came shortly after the COVID-19 pandemic led to the temporary closure of the Avenidas Rose Kleiner Center – an adult day care provider in Mountain View that had been helping her grandmother, who deals with memory loss, for the past couple of years. Every weekday, the care facility offers a variety of group activities, including drum circles, walks and trivia games, as well as individualized services like physical therapy and health monitoring.
Without this support, Cross said that she could see her grandmother’s health starting to deteriorate just a few weeks into the shutdown.
“Like many seniors, [she] went from being independent to very dependent without the socialization and structure that Avenidas provided,” Cross said.
After taking over as her grandmother’s full-time care provider, Cross had very little time to care for herself. Even though she previously had a demanding job at a start-up veterinarian emergency hospital, Cross said she was not prepared for the amount of work that being a caretaker would require. When Avenidas reopened in July 2021, Cross was very excited for both herself and her grandmother.
“For me, Avenidas is the difference between a miserable life spent in isolation and a happy one,” Cross said.
Cross’ grandmother, who is now 98, still comes to the Rose Kleiner Center three days a week, but she and many others are currently facing uncertainty about the future of the care they receive due to upcoming changes to Medicaid funding.
With the implementation of the Trump administration’s “One Big Beautiful Bill,” which was signed into law this July, some Avenidas participants may face higher out-of-pocket costs because of reduced Medicaid coverage.
According to Nancy Keegan, program director at the Rose Kleiner Center, California’s Medicaid program – called Medi-Cal – will start seeing reductions at the start of next year as the state tightens its budget in response to federal cuts. There are likely to be further limitations on what Medi-Cal will cover for services like adult day health care, which are optional for the state to pay for.
“Nobody knows what to brace for, but these decisions impact our participants’ lives,” Keegan wrote in an email to the Voice.
More than half of the participants at the Rose Kleiner Center use Medi-Cal to help pay for its services. Medi-Cal partially covers the cost for those who receive health care as part of their adult day program, Keegan said.
On Monday, Dec. 8, U.S. Rep. Sam Liccardo visited the Mountain View facility to meet participants, speak with family members who provide care and learn more about the services that are available. He said that supporting places like Avenidas is important now more than ever so that families who care for their loved ones have options other than in-home nursing, which can be cost-prohibitive for many.
“We need to leverage the good ideas in the work of places like Avenidas to help us find better ways, and more dignified ways, to care for those in need,” Liccardo told the Voice.
In an attempt to mitigate the effects that Medi-Cal cuts might have on individuals and families who rely on the center for care, Avenidas is working to expand fundraising and grow its scholarship fund. According to Avenidas President and CEO Kristina Lugo, the facility, which has been operating since 1978, is reaching out to foundations, donors and health partners who understand that adult day health care “prevents medical crises.”
“Even with all of this, the cuts could leave some families with less coverage than they need,” Lugo wrote in an email. “The worst case would be turning someone away, and we are working hard to avoid that by bringing in as much outside support as possible.”
Another policy issue, separate from the Medicaid cuts, that the center is tracking is the Older Americans Act, which expired in September 2024 but continues to be funded through temporary measures while Congress works on reauthorization. This law helps to subsidize the costs for adult day care and covers limited funding for in-home care, but currently, its future hangs in the balance.
After hearing testimonies from family members like Cross, Liccardo said he felt “inspired” by those who give up their careers to care for loved ones. As a whole, Liccardo said the experience affirmed for him the “imperative” of getting the Older Americans Act reauthorized.
“It’s critical to ensure that programs like this get the funding they need to be able to offer services to dozens of particularly older adults,” Liccardo said. “This is a lifesaver, not just for the adults who are served, but for the families.”
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