Aging | HealthyCal
 

Posts Tagged aging

  

The Health Perils of Aging: Lonely and Sick

Published: May 13, 2012 | Comments (3)

By Matt Perry

The grim effects of smoking, drinking, and poor eating are commonly cited by doctors as appalling and expensive health scourges. Yet for aging Californians, an often hidden health plague can be just as deadly: loneliness.

Social isolation and its common offspring – loneliness – became a political hot potato when California recently cut back on its adult day health care program, disqualifying 20% of the state’s older and disabled citizens from its attendance rolls. Families who depended on the centers for medical supervision and social interaction suddenly had to scramble to find new programs to care for these relatives.

For seniors with or without families, this often meant more time home alone.

“They’re just going to go home, watch TV and decline,” predicted Katya Hope, acting director of the Golden State Adult Day Health Care Center in San Francisco’s Tenderloin district, of the approximately 7,000 clients cut from the state program.

Research linking social isolation to poor health is abundant.

“It’s as large a risk factor for mortality as cigarette smoking,” says Laura Carstensen, director of the Stanford Center on Longevity.

Loneliness can increase depression, neuroses, pessimism, alcoholism, and suicidal thoughts. It can also disrupt sleep and reduce self-esteem.

Its physical effects are equally disastrous. It can increase blood pressure, limit the body’s ability to fight off illness, and has been linked to higher death rates. Social isolation can increase obesity and speed the progression of Alzheimer’s disease.

From a public health perspective, the most damning effects of social isolation are that it prevents older adults from living independently and exercising.

Long-term, all of these factors can cost the state money in chronic disease management and skilled nursing dollars.

Because funding for programs – like adult day health care – can end abruptly, creative local initiatives to address social isolation dot the state.

Some of these programs use the phone to reach seniors who are shut-ins or lack mobility.

The Senior Center Without Walls, based in Oakland, holds nearly 70 free classes a week for isolated seniors who call a central number to join a telephone classroom.

Classes include health information, poetry readings, brain games, cooking, gardening, and a popular travel club.

Director Terry Englehart, who started the program in 2004 with six women to tell jokes, said last fiscal year the center had 667 participants.

Many have lost their spouses or confidantes.

“They have found a community they belong to,” she says. “They have something to look forward to. They have friends.”

Every day of the year, the center hosts a 9 a.m. “Gratitude” call.

On one day, there are 15 older adults on the long-distance teleconference. Some are chronically ill. Although they have never met in person, the sense of community, friendship – even love – is palpable.

They give thanks for phone calls from children, medicine reminders, electricity, reality TV, museums, casinos, dogs, cats, fog, sleep, and blooming spring flowers.

“I’m just very grateful that I went for a walk this morning and they weren’t narrow hallways,” said one man recently discharged from the hospital.

In Northern California, volunteers at the Eskaton senior living community’s Telephone Reassurance call 550 older adults in a three-county area in and around Sacramento.

Callers socialize with clients, check on their health, or remind them to take medicines – even to eat and drink. They can also set up home visits or suggest social services, including financial advice.

“A lot of the folks we call live totally on their own,” says Terri Becker, director of the telephone reassurance program, which is one of many around the state. Becker says many are women who have outlived their husbands. Others live in poor neighborhoods, are financially destitute, or suffer from dementia. All crave personal contact.

Becker says the phone calls provide a sense of security in a confused world.

“Their anxiety goes way down,” she says. “Medicines can only help so much.”

Indeed, some experts decry the modern medical model that depends so heavily on pharmaceutical drugs.

Walking outside with a neighbor does “more good than all the friggin’ pills in the pharmacy,” says Dr. Walter Bortz, a “robust aging” expert and author of the book “We Live Too Short and Die Too Long.” Bortz currently teaches the Stanford course “Exploring the Human Potential.”

Former Harvard University president Derek Bok in his book “The Politics of Happiness” writes that good health and happiness are clearly intertwined. Yet Bok says that a clean bill of health from a physician is only “roughly correlated” with happiness.

The leading factor in being healthy and happy according to Bok: social connections.

A 2010 study by AARP of 3,000 people 45 and over found a whopping 35% “chronically lonely” – up significantly from 20% a decade earlier. Surprisingly, the loneliest age groups were in their 40s and 50s.

Peter Szutu, CEO of the Oakland’s Center for Elders’ Independence, says that older adults bounce back from sickness and stress with four factors: a community they belong to, meaningful activity, hope, and a confidante.

Yet in aging California, social isolation is expected to grow right with its population.

By 2030, an estimated one in five Californians will be 60 and over, says Mariko Yamada, chair of the state Assembly’s Aging and Long Term Care committee.

Yamada says a revolution in aging services is needed to survive a future often termed “the silver tsunami.”

By contrast, she says fellow legislators have oversimplified a complex issue.

‘There’s a fundamental flaw in the way we look at services in general,” says Yamada, who has worked in social services for 38 years. “We try to define them as either social or medical… It’s really both.”

One program that blends good health and social interaction is offered in San Diego county, where the Sharp Rees-Stealy Medical Group conducts six-week chronic disease management classes for patients.

A hallmark of the group’s Healthier Living program: the buddy system.

“Everybody gets a buddy,” says Kelly Dutcher, a wellness education specialist and class supervisor. At the end of each session, patients create an action plan for the following week.

“When they call their buddy mid-week it’s really to check in on those action plans,” says Dutcher. “So much of why people are successful is accountability.”

“I liked exchanging phone numbers and have (sic) a partner,” wrote one participant. “It motivated me.”

Dutcher says the program indirectly addresses social isolation: “Coming to this class may be the only time they get out of the house that week.”

Statewide, the PEARLS program treats older adults at home who are suffering from mild depression. Developed by Dr. Ed Wagner, who has developed models to treat chronic disease, PEARLS emphasizes an increase in physical and social activities. There are five programs in California, with two more in development.

Older adults who maintain or increase their social connections can slow both physical and cognitive decline, according to a study last year by the Population Research Center at the University of Texas in Austin.

In Fremont, two ethnic groups wracked by social isolation are Pakistanis and Afghanis – the latter suffering high rates of PTSD.

The city’s Pathways to Positive Aging – Fremont’s collaboration with the Tri-City Elder Coaltion – has built bridges to seniors in both ethnic communities. After creating the Afghan Elder Association and the Muslim Support Group, health programs were then introduced to address obesity, diabetes, and other health concerns.

Older adults in these communities were heavily isolated and not getting proper healthcare, says Ray Grimm, project coordinator for Pathways to Positive Aging. Creating these social organizations played a major role in improving health outcomes.

“Once you get them linked you keep them out of the emergency rooms, and hopefully out of the hospitals,” says Grimm.

In the city famously called “The Happiest Place in the USA” – San Luis Obispo – Wilshire Community Services offers both “senior peer counseling” (peer advice for those 55 and older) and Caring Callers (all-ages volunteers who make free weekly in-home visits to older adults).

Heartened by such community programs around the state, Yamada nevertheless anticipates a bleak future unless radical service improvements are made for aging Californians.

“It’s kind of like watching the Titanic approach the iceberg, and knowing that a lot of people are going to die or be hurt.”

First of two parts. In Part 2, Matt Perry will profile the Senior Center Without Walls, which connects older adults with new friends via telephone conference calls.

 

Long term care program faces big hurdles

Published: September 14, 2011 | 1 Comment

By Herbert A. Sample

As the U.S. population ages in the coming decades, the need for some sort of insurance to cover long-term health care expenses – such as in-home support services – will also rise.

With this in mind, Congress and the Obama Administration last year included in the controversial health care reform act a little-discussed provision to implement a government-run long-term health care insurance program known as CLASS in October 2012.

Yet with a year to go before that deadline, officials with the U.S. Department of Health and Human Services are finding it difficult to devise a mix of benefits and premium levels that both would make such coverage attractive and affordable for consumers, and ensure the program is actuarially sound. That struggle may delay the program’s start until the fall of 2013, if not later.

At the same time, the private market for such insurance, once robust, has declined in recent years. And average premiums that hover in the hundreds of dollars a month are a hard sell to workers in their 20s and 30s – in the midst of a recession — who may not see a need for coverage that they aren’t likely to use for two to three decades down the road.


This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.



Nonetheless, the need exists and will grow larger in the coming years, both advocates and critics of the fledgling CLASS program agree.

“If you just look broadly at all adults, only 3 percent of the population has any sort of private long term care, and if you look at just older people, people over 65, I think it’s about 10 percent,” said Joe Caldwell, director of Long-Term Services and Supports Policy at the National Council on Aging, which backs CLASS.

“So people aren’t really prepared at all. And like I said, it really ends up being Medicaid that provides a lot of those services, but we make people become poor to qualify for long-term care through Medicaid,” he added.

The Community Living Assistance Services and Supports Act is a relatively short 20 pages of the huge Affordable Care Act, which was enacted in March 2010. It mandated a voluntary long-term care insurance program, to be implemented no earlier than October 2012.

According to the law, employers who sign up for the program would automatically enroll their workers unless individual employees opt out. After a five-year vesting period of consistent premium payments, a beneficiary would be eligible for average benefits of no less than $50 a day to help pay for a range of services at home or in a nursing facility, such as eating, bathing, dressing and using the toilet.

Advocates say the program was not envisioned to fully cover such services, which tend to cost much more than $50 per day, but more to supplement whatever other resources beneficiaries can draw on. It also, they contend, would help patients avoid becoming destitute to qualify for Medicaid, which requires states to cover nursing home expenses but does not mandate coverage of in-home services.

In a February speech, HHS Secretary Kathleen Sebelius noted that some 10 million Americans currently need long-term services, which could rise to 15 million by 2020. She also said one out of six people who reach the age of 65 eventually will spend more than $100,000 on long-term care.

According to a July survey of almost 1,500 registered California voters age 40 and over by the SCAN Foundation and the UCLA Center for Health Policy Research, two-thirds of the respondents said they could not afford more than three months of nursing home care. About four in ten could not afford a single month of care, and only 14 percent said they’ve purchased long‐term care insurance.

One major sticking point for CLASS, which by law cannot be subsidized with taxpayer funds, is the cost to consumers. Average monthly premiums could be in the $160 range if the average daily benefit reaches $75, according to a 2009 estimate by the American Academy of Actuaries, a 16,000-member professional group that takes no position on the law itself. The Academy stressed, though, that major changes in the law are needed to make the program sufficiently sound to offer premiums even at that level.

Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services, an arm of the Health and Human Services Department, reported last year that average premiums would have to be set at $240 per month to adequately finance the program.

Back in 2009, when Congress was considering the CLASS proposal as part of the larger health reform bill, Foster and other administration officials privately raised concerns about its viability, according to The Associated Press. William Marton, who still heads the HHS Division of Disability and Aging Policy, wrote in an email that CLASS “seems like a recipe for disaster” because it would not attract sufficient numbers of healthy subscribers, AP reported Wednesday.]

These concerns center on the concept of “adverse selection.”

With auto insurance, for example, the state requires everyone who operates a car to buy coverage. The private companies that offer such insurance theoretically pay out less in payments for accidents and other covered events, and administrative costs, than they collect in premiums from a large pool of insured drivers.

But the worry with CLASS is that, being voluntary, the pool of persons who enroll will include too many individuals who currently suffer from health problems or who anticipate a need for coverage in the future, and too few persons who pay premiums but subsequently collect little or no benefits.

Further, setting the premium at a rate sufficient to cover CLASS benefits “further discourages persons in better health from participating, thereby leading to additional premium increases. This effect has been termed the ‘classic assessment spiral’ or ‘insurance death spiral,’” Foster said.

But while CLASS faces hurdles getting started, the private long-term care market is retrenching. According to LIMRA, an industry research group, 11 firms that once were among the top 10 long-term health care insurers no longer offer individual coverage, including MetLife, Unum, Allianz, CAN and IDS. Others have asked state regulators for big premium increases.

Nationally, a LIMRA spokeswoman said, the number of carriers has dropped from more than 100 a decade ago to fewer than 50 now. In California, that number has dropped from 28 in 2003 to 17 this year, according to state Department of Insurance records.

The last few years have been particularly disappointing to the industry as fewer policies were purchased despite the public’s greater awareness about the need for such coverage, a LIMRA report from June 2010 noted.

Some advocates contend CLASS, once it’s up and running, will improve public knowledge about and willingness to buy long-term care insurance, whether from private firms or the government program. But politically speaking, CLASS’ future faces tough sledding. The so-called “Gang of Six,” a bipartisan group of U.S. senators that tried earlier this year to devise a plan to reduce the national deficit and debt, called for its repeal. In 2009, the Democratic chair of the Senate Budget Committee called CLASS “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.”

Some opponents contend the program as currently structured is so financially unviable that Congress eventually will have to bail it out. But as a philosophical matter, they simply don’t think the government should be offering long-term health care insurance.

“We certainly agree that there’s a significant policy concern with regards to long term care. It’s something that most Americans don’t prepare for adequately,” said Kathryn Nix, a policy analyst at The Heritage Foundation, a conservative think tank that opposes CLASS.

“The right way to approach this is to … encourage individuals to save for their anticipated needs. But it’s not for government to intervene in the market. Government intervention has a place and this is not it,” she added.

The actuarial issues that critics have identified have led even the administration to agree that major alterations are necessary, most of which they contend can be handled administratively. Nix disagreed, saying the administration will have to approach Congress for most of the changes it’s seeking.

In her February address, Sebelius said her staff is exploring ways of raising awareness of the program, closing loopholes, making it more flexible for employers and indexing premiums to inflation, just as benefits are now tied.

“It would be irresponsible to ignore the concerns about the CLASS program’s long-term sustainability in its current form,” she said. “But it would be unconscionable to ignore the likelihood that without a CLASS Act, countless Americans will have to clear out their savings or leave their homes and loved ones in order to get the services and supports they need.”

A HHS spokesman declined to comment on the status of the administration’s deliberations. The Congressional Budget Office currently assumes a one-year delay in implementation.

“Trying to get some healthy people in and having a good mix of people in there is going to be the challenge,” said Sean Coffey, at the Family Caregiver Alliance in San Francisco, which supports CLASS. “If they can do that, then it should be sustainable.”

Coffey noted that the CLASS law requires the HHS secretary to certify that it will be solvent over 75 years before it can be implemented. “At least my sense of Secretary Sebelius is that she’s not going to do the program if she can’t get it to work within the parameters of the law of being self-sustaining,” he added.

Herbert A. Sample is a freelance writer based in Los Angeles. He can be reached at has ample@mac.com.

 

Napa moves against elder care abuse

Published: June 23, 2011 | 1 Comment

By Meda Freeman

With reports of elder abuse rising, Napa County is taking the lead in protecting seniors from unscrupulous or predatory caregivers by becoming the first in California to require criminal background checks for home-care aides.

Starting July 1, in-home assistants who help elderly or disabled adults with bathing, dressing and other daily tasks will need to pass background screenings and buy annual permits to work anywhere in the county. Local law enforcement officials and senior advocates say the new law will arm vulnerable consumers with crucial information and help close an alarming gap in the oversight of California’s private-care industry.


This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.


“This ordinance will save lives,” said Napa County District Attorney Gary Lieberstein, who refers to the fatal stabbing of a 70-year-old paraplegic woman in Pleasant Hill last year as an extreme but real example of the risk elderly and disabled people take when they take strangers into their homes.

Lieberstein said Mary Jane Scanlon hired Diane Warrick through a Craigslist post, unaware her new helper’s experience included taking hostages in Napa County, battling police in a shoot-out and then spending four years in a state hospital for the 1997 stand-off.

If Warrick’s violent history had been exposed during a background check, “no one in their right mind would have hired her,” Lieberstein said. Instead, Scanlon let Warrick move into her home, and six months later, Warrick stabbed her defenseless boss in the chest. Warrick was convicted of second-degree murder in March and sentenced to 31 years to life in prison.

Elder abuse is a label that applies not only to violent crimes but also to property crimes like theft and forgery and psychological abuse like coercion and intimidation. Experts say the prevalence of elder abuse in California is difficult to quantify because it often goes unnoticed or unreported, and when abuse is alleged, any number of law enforcement or social service agencies might investigate, depending on the nature or setting of the report.

“We’re certainly getting increased reports of abuse, but whether that’s an increase in awareness or an increase in the problem, we don’t have a way of knowing,” said Lisa Nerenberg, chairwoman of the California Elder Justice Workgroup, which advocates for stronger reporting and support services. “And not only are we seeing more cases, we’re seeing cases of more complicated abuse.”

The issue of elder abuse is only expected to grow as baby boomers age. California’s senior population will double to about 6.4 million by 2025, with the majority of boomers hitting their 80s around 2030, according to government projections. As a result, home care for the elderly is one of the fastest-growing job markets.

“Caregiver Roulette,” a recent investigative report by the California Senate Office of Oversight and Outcomes, explains California does regulate nursing care in private homes but is among a minority of states without regulations for the agencies and individuals who provide help with grooming and day-to-day chores. A business license is all that is required of the private agencies that place these caregivers in homes.

The report describes how dependent adults were swindled out of their savings or otherwise victimized by personal helpers with criminal records never disclosed to their elderly employers. When Principal Consultant John Hill investigated Craigslist ads posted by helpful-sounding caregivers he found some of their backgrounds included embezzlement, methamphetamine sales, child abuse, theft, battery, prostitution and other activities a potential client would want to know about.

According to the report, there is a state law that lets the elderly or disabled request a Department of Justice background check on a potential caregiver, but the law has not been widely publicized and there is no clear system for helping the public make the request or interpret the results.

Oversight Office investigators recommend the Legislature consider passing a law regulating home care, creating a statewide family-care registry and establishing more consistent standards for background checks conducted by private agencies.

Lawmakers introduced two bills this year to close the current regulatory gap. The state Senate recently approved SB 411 by Senator Curren Price, D-Los Angeles, which would require licensure and accreditation for in-home care agencies and criminal background checks and state certification for providers. An Assembly committee is now reviewing the bill. The other bill – AB 899 by Assemblywoman Mariko Yamada, D-Davis – would require licensure of home-care agencies and background screenings for caregivers, but this bill is on hold in the Assembly appropriations committee.

Lieberstein, Napa’s prosecutor, said that until there is statewide oversight, other local governments also might be motivated to enact caregiver ordinances.
“Prevention starts at home, and we weren’t willing to sit around and wait for a state law to be passed,” he said.

Napa’s Board of Supervisors and each city council adopted a caregiver ordinance with identical provisions, so home aides from St. Helena to American Canyon are subject to the same requirements. They will need to apply for a $20 permit through the Napa-Solano Area Agency on Agency and pay a $90 fee for their first background check. The permit will be good for one year only, and background checks will be required every year at renewal.

Representatives of the state’s largest union of home-care aides said members support increased oversight but would prefer any new requirements be statewide. .
“While we appreciate efforts on all levels to establish standards of work and care, we feel like an individual county approach is not the best way forward,” said Laphonza Butler, president of SEIU’s United Long Term Care Workers of Northern California. “The state should establish one standard so the industry can be clear.”

Joe Hafkenschiel, president of California Health Services at Home, another association of caregivers, agrees. “The problem I see in doing it on a county by county basis is we could have different requirements in different counties. I think it’s better to do it on a statewide basis.”

Napa County, meanwhile, has launched a marketing campaign to raise awareness of its new law, and outreach includes a YouTube dramatization of caregiver-hiring gone bad. Officials say the goal is to educate residents about this new safeguard, not to round up unlicensed caregivers.

“We’re getting the word out that people are supposed to see the caregiver’s permit, and if they don’t have a permit, it’s a red flag,” Lieberstein said.

Ruth Marsh of Napa said a vetting process for home aides would have been a big help when she needed a caregiver for her mother. Marsh ended up hiring someone referred by a clerk at the supermarket and soon noticed antiques and other valuables disappearing from her mom’s home. The caregiver denied taking the items, but Marsh eventually fired her.

“She cried, ‘I love your mom so much. I’d never do something like that.’ She was a good actor.”

 

Health center closures could leave thousands without options

Published: June 13, 2011 | No Comments


This article is one in an occasional series on aging with dignity and public policy that affects the ability of elders to live independently. For a complete archive of the articles, click here.

By Herbert A. Sample

In 2002, Nina Nolcox found her calling. After years as a registered nurse in skilled nursing facilities and hospitals, often on the nightshift, Nolcox started working in an adult day health care center in South Los Angeles. Four years later, she bought the business, Graceful Senescence, with the aid of a small business loan.

Nolcox now employs 26 people and provides health services to about 115 mainly African American and Latino seniors who suffer from diabetes, Alzheimer’s, high blood pressure and other chronic ailments.

Adult Day Health Care is “probably the most logical health care model that I’ve been a part of,” Nolcox said. “I fell in love with it.”

But Nolcox’s clients might soon have to go elsewhere for their care, or get none at all, because the state appears certain to eliminate the three-decades old Adult Day Health Care program in the next few months. More than 35,000 Californians will see their services end, though some as yet undetermined number will be transition to other forms of care.

Paradoxically, the U.S. government is beginning to prod states to establish or expand programs that aim to do what ADHC does in California -– steer seniors and disabled adults away from expensive nursing homes and hospitals, and into community- and home-based care.

“It is a huge disconnect,” said Lydia Missaelides, executive director of the California Association for Adult Day Services, which represents ADHC centers. “At the very moment that the incentive and the public awareness and the rules and the pilot projects and the innovation is coming out from the federal level to the states…here we are in California just taking this huge step backwards and losing an important part of this continuum of care that we need.”

Few really want to kill ADHC, which costs $340 million a year – about $169 million of it in state general funds and the rest from the U.S. treasury. Though the measure passed by state legislators that authorized ADHC’s demise alleged that the program remains vulnerable to fraud, that is rarely invoked as a reason for shutting it down.

Instead, in what has become a refrain for many cuts throughout state government, officials faced with California’s budget crunch admit they have few choices other than to eliminate what is, after all, an optional benefit under federal Medicaid laws.

“We recognize its value and it has served people very well,” Norman Williams, spokesman for the state Department of Health Care Services, said of ADHC. “We have to make some tough choices on what to continue and what to reduce and what to eliminate.”

For poor seniors with chronic illnesses and younger disabled adults, ADHC centers are a ticket out of their residences and into a more socially rich environment where they can receive a number of health-related services – such as physical, occupational and speech therapy, dietary information, and blood pressure and blood sugar monitoring — that is more costly if done in the home by a team of personnel. Centers’ group activities also provide social interaction and physical exercise that leads to healthier emotional lives, Missaelides said.

“People can be just as easily institutionalized in their own homes if they become terribly isolated as they can be by living in an institution,” she added.

The birth of ADHC in the late 1970s was in part a reaction to stories exposing the warehousing of the elderly in nursing homes and other facilities. Other states emulated it; about a dozen authorize similar programs now, according to federal officials.

More than 300 centers operate in California, the bulk of them in Los Angeles County. About 80 percent of the beneficiaries are seniors, and others include younger patients who suffer from traumatic brain injuries, cognitive diseases such as Alzheimer’s, and developmental disabilities.

Nolcox said she observed little coordination between doctors and other care providers in most of her past nursing jobs. But the ADHC program’s requirement for a multi-disciplinary approach to each beneficiary impressed her.

“Now I can deal with all areas that are potentially causing the problems with this person and close the gap,” Nolcox said. “We do it in a team fashion….It was the first place that I had been that I was able to feel like I was having an impact in actually decreasing health care costs and improving quality of life.”

As beneficial and cost-effective as ADHC may be, federal rules consider it voluntary for states while more expensive nursing home care are mandatory. That’s why twice before in recent budget struggles, California officials have tried to eliminate the program. Though reluctantly, they appear to have succeeded this time.

The Legislature authorized ADHC’s end earlier this year, and the federal Centers for Medicare and Medicaid Services has until mid-August to act on the Brown Administration’s proposal, according to a CMS official who did not want to be identified. CMS is examining the state’s plans to transition at least some ADHC beneficiaries into other services, but the agency is expected to go along with ending the program – if for no other reason than the state is not required to maintain it.

At the same time, the federal government has begun to push a goal – voiced in, for example, a little-noticed part of last year’s health care reform law – that states steer seniors into home- and community-based services, and classify more costly nursing homes and other institutions as a “fall-back option.”

The health care reform law funded two such programs: The Money Follows the Person Demonstration, which was originally authorized in 2005, and the newer Community First Choice Medicaid Option. Thirteen states, though not California, were awarded $45 million in February to implement their MFP programs.

Regulations for CFCO are due later this year, and it will not be implemented before October. Some estimates suggest California could receive about $125 million annually from it. But federal officials said CFCO money is aimed at home supportive services – such as cooking, cleaning, bathing and transportation to doctors’ offices – and not the more directly health-related services ADHC provides.

The seeming incongruity of the federal goals and California’s elimination of ADHC is not lost on federal officials.

“States struggle with that,” the CMS official said. “They can’t eliminate the nursing homes benefits. They can’t eliminate the hospital benefits….And if they need to make a cut in their budget, they need to look at where they can cut, and they have the ability to cut an optional service.”

Advocates for ADHC worry that the guts of a program will be difficult to replicate once California’s economy and budget stabilizes.

“It ain’t coming back,” Casey Young, a lobbyist for AARP California. “These are businesses that are going to close, and the infrastructure will be gone.”

Nolcox’ because the state appears certain to eliminate the three decade-old Adult Day Health Care program in the next few months.

Graceful Senescence could be one of them, Nolcox said. Her entire business, personal finances and employees are now in danger.

“I might be forced to lay off 26 people and claim personal bankruptcy,” she said. “Remember, I have an SBA loan.”

Similarly, the non-profit Yolo Adult Day Health Center in Woodland may have to close if there is no seamless transition from ADHC to another program, said Dawn Myers Purkey, the center’s program manager and immediate past president of CAADS.

“We could bear at most several months worth of support as we slowly work toward completely closing our doors. There’s no pretending for us that we’re going to survive,” said Purkey, whose center provides services to 80 beneficiaries and employs 17 workers.

Missaelides said CAADS is working with center owners to diversify by attracting patients who can pay themselves or through private insurance. “It’s really hard right now to say what will happen,” she said.

It’s also difficult to predict the future of beneficiaries who aren’t transferred to other programs. Advocates complain the state has offered few concrete answers, and they suggest a significant number of former ADHC patients will end up in emergency rooms, hospitals and nursing homes – at a higher government cost and exactly counter to the approach the U.S. is emphasizing.

State legislators have signaled support for a new program called Keeping Adults Free From Institutions, into which the former ADHC beneficiaries with the worst conditions would transition. It would cost about $170 million, with the state and federal governments sharing the burden. But KAFI has not yet won final approval, and Department of Health Care Services officials say they won’t start working on it until it does.

There’s a bigger, longer-term worry, said Gary Passmore, director of the Congress of California Seniors: The number of California’s senior citizens will rise from 4½ million to 10 million in about 20 years.

“It is ironic and tragic that in the face of this projected demand, the State of California is actually cutting back,” he said. “We have…put our heads in the sand, and (are) in denial that millions of people are going to need services and care.”

State officials say they understand the demographics, even as they grapple in the here and now with extremely tight bottom lines. The demise of ADHC is going to force some efficiencies into the mix of services the state offers, while the health care reform law will provide funds and guidance to eventually do more, Williams said.

“We are looking at all of these with an eye to the future to provide to all segments of the Medi-Cal population,” he added, “including and most urgently, in terms of time, the seniors.”

Herbert A. Sample is a freelance writer in Los Angeles. He can be reached at hasample@mac.com.

 

Older Americans less healthy than British but live longer, study finds

Published: November 4, 2010 | No Comments

Older Americans live as long or longer than their English counterparts even though Americans suffer from much higher rates of chronic disease, according to a new study by researchers from the RAND Corporation and the Institute for Fiscal Studies in London.

The study suggests that medical care in the United States, at least for older Americans, is better than it is in England, but Americans’ lifestyles, behavior and perhaps their living conditions contribute to a greater rate of illness. Things like occupation, marital status, education, obesity and smoking influence health and the onset of disease more than medical care, the authors said.

The study found that Americans aged 55 and older were more likely to have diabetes, high blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Diabetes was almost twice as common in the United States, and people in their 70s were more than twice as likely to be diagnosed with cancer in the United States as their peers in England.

But death rates among Americans were about the same as the British among those aged 55 to 64, and lower among those 70 and older.

Researchers cite two possible explanations for this disparity. Either the illnesses studied result in a higher death rate in England, or the English are diagnosed at a later stage of the disease than are Americans.

“Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States,” said James P. Smith, a RAND researcher and co-author of the study, which was published in the journal Demography.

“The United States’ health problem is not fundamentally a health care or insurance problem, at least at older ages,” said James Banks of the Institute for Fiscal Studies. “It is a problem of excess illness, and the solution to that problem may lie outside the health care delivery system. The solution may be to alter lifestyles or other behaviors.”

For more information on this research, go here.

–Daniel Weintraub

 
 
 

Home | Cal Health Report | Community Report | Legislation | Ideas | Forums | About Us

©2013 HealthyCal.org