By Matt Perry
California Health Report
Monday’s launch of California’s new, smaller adult day health care program unleashed an emotional torrent of relief and anger for thousands of current clients and their providers after more than a year of threatened closures, lawsuits, patient assessments, rushed timelines and maddening uncertainty.
Over the weekend, center administrators phoned frustrated clients still in limbo about their eligibility for the new Community-Based Adult Services (CBAS) program, telling them “Stay home” or “Come in until further notice” after a contempt motion against the state aimed at including more patients into the program was postponed Friday.
More than 80 percent of about 35,000 existing clients have been approved for the new program. Original estimates by the state were that just 50 percent would be found eligible.
“Once the appeals are all said and done I think it’s going to be 90 percent,” said Lydia Missaelides, executive director for the California Association for Adult Day Services.
The program provides health care and social services to adults, mostly older people, who can’t be cared for at home but, with the assistance of the day health care centers, can remain independent and stay out of nursing homes.
On Monday, many centers decided to gamble and provide service to denied clients in hopes they’ll win pending appeals, and that the centers will be paid retroactively.
“We’re still working out the details of this issue,” said Anthony Cava, a spokesperson for the state.
Some of the 268 centers now offering adult day health services – including Eskaton Adult Day Health Center Carmichael – were relieved to find all of their clients approved for the new program in final lists sent out by the Department of Aging last Wednesday.
Most have not been so lucky.
Steven Andrews, program director for Rancho Cordova Adult Day Health Care, said 30 of his site’s 200 clients were denied entry into the new program. But the facility will continue to provide service to all of them, even those deemed ineligible and on appeal.
“Everyone’s taking a risk in not getting paid,” Andrews said.
But one center in San Diego County made the difficult decision to turn clients away.
“We have to stop them from coming,” sighed Irene Nashtut, administrator for AmeriCare Adult Day Health Care Center in San Marcos, which closed its doors to 60 of its clients – one-quarter of its population.
“If we’re not going to get paid we cannot continue them coming to the program,” says Nashtut. “It is a huge financial commitment (for) our company. It is not a small number of people.”
After many sleepless nights, Nashtut remains worried that her clients won’t receive needed medical supervision or community support at home.
Kevin Vanderhagen had a stroke at 36, and suffers from memory loss, depression, diverticulitis, and kidney malfunction. An AmeriCare client, he was found ineligible for CBAS.
“It’s kind of rough,” says his wife Grace, a hairdresser. “You never know when he’s going to have another seizure or something, or his blood pressure’s going to go up.”
She says losing the social aspects of adult day health compounds her husband’s problems.
“For him to make friends and stuff it’s really hard,” she adds. “He has to spend a lot of time at home and he gets really depressed.”
The Department of Health Care Services reports that 7,800 of the nearly 40,000 total clients assessed were denied CBAS under stricter guidelines than those for its predecessor – Adult Day Health Care (ADHC).
After Governor Jerry Brown proposed eliminating ADHC last year, Disability Rights California (DRC) filed a lawsuit to keep the centers open. The ensuing settlement agreement produced the new CBAS program with a budget of $83 million – a savings of $88 million.
The CBAS launch was delayed one month until April 1 to allow Medi-Cal more time to assess patients.
A recent contempt motion filed by Disability Rights California against the state in federal district court claimed the state had agreed to a win-win solution for clients termed “presumptively eligible” – place them immediately into the new program while allowing the state more time to assess their eligibility for continued CBAS participation.
Meanwhile, thousands of these clients have been declared ineligible for the new program.
The contempt motion was postponed to allow both sides more time to iron out eligibility standards.
At Golden State Adult Day Health Care Center in San Francisco’s Tenderloin district, 126 of its 300 mostly Russian and Chinese clients have been denied acceptance into CBAS.
Despite the legal uncertainty over whom is eligible, the center yesterday conducted business as usual – for now.
“They are here this week at least,” said social worker Ted Snyderman.
“That’s the kind of commitment people have here,” said acting director Katya Hope.
But Hope says the center may be faced with staff layoffs, and fears for her clients’ safety if they are forced to stay at home, in what she terms “solitary confinement.”
“These are people who are very, very demented and unsafe at home,” says Hope.
Bay Area Legal Aid and other attorneys are helping 42 of the center’s clients during the 90-day appeals process, which may not be resolved until June.
Many centers are also lodging complaints about the transition’s “enhanced case management” plan, which is intended to help denied clients find substitute services to replace those provided at the centers.
Currently at least 2,000 clients are now receiving enhanced case management, according to the state.
Most of the complaints center on the state’s Medi-Cal contractor, APS Healthcare, headquartered in White Plains, NY.
The centers say replacement services often don’t exist – particularly for ethnic clients – and criticize phone support by APS as out-of-touch with the real needs of patients.
“Their idea of case management is talking over the phone with someone who doesn’t speak the language well,” jokes Hope.
Grace Vanderhagen received a call from an APS representative Friday night at 8:00 p.m.
“He gave me all these names of these places in San Diego,” she says, “but I don’t live in San Diego.”
“They have no idea what they’re talking about,” says Nashtut of APS. “We are very frustrated with this whole process.
Yet Nashtut does offer kudos to one organization involved in the transition.
Of the five managed health care plans that will eventually supervise the program in San Diego County, only one has contacted AmeriCare: Molina Healthcare California.
A Molina executive says the health plan used the progressive collaborative Healthy San Diego to speed contact with the 21 adult day health facilities in the county.
The health plan has already developed care plans for each of the 37 San Diego county clients denied CBAS who are currently enrolled with Molina, says Andrew Whitelock, director of government contracts.
Rather than simply sending clients to senior centers, Molina is creating an integrated care approach that includes sending them to in-network providers for services like speech or occupational therapy.
Molina also provides Medi-Cal coverage in three other California counties.
Despite continued confusion surrounding CBAS, all sides can agree on one issue: the transition has left everyone exhausted – state officials, center operators, attorneys, clients, and their families.
“I don’t know if I have the time to look for a place because I have to work,” says Grace Vanderhagen, of her husband, who is now staying at home. “And nobody’s open on the weekends.”