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On Deadline: Does it matter whether 'senior day health' programs survive?

Uploaded: Jun 29, 2011
One could easily rephrase the question above: How much do seniors matter to society, our communities, our state or nation?

The answer has a particular relevance to Palo Alto, Mountain View and communities in south San Mateo County that are served by the Rose Kleiner Senior Day Health Center. The center stands to lose about half of its 60 spaces due to cutbacks in MediCal funding -- part of the state and federal budget disasters that are washing away so many social and educational programs.

The Kleiner center will remain open, officials vow, thanks to a strong base of client, family and community support. At the same time, our population demographic continues to grow older, both in the still healthy Baby Boomer bracket and in the more frail elderly, called by some the "old old."

But there is a broader significance. There are several hundred such programs in California. Whether they make it through the California budget crisis and disgusting partisan battles is a very real microcosm of what's happening to "social programs" statewide and nationwide.

A glimpse of the impending crisis was provided last Tuesday to 20 former board members of Avenidas, once known as the unwieldy handle of "Senior Coordinating Council of the Midpeninsula Area, Inc." -- or just SCC.

Lisa Hendrickson, in her 12th year as Avenidas' executive director, outlined the difficulties Avenidas faces Tuesday at a luncheon for former board members of the organization, now more than four decades old. Some of the board members served as far back as the early 1980s, and attendees included former Palo Alto mayors Jim Burch and Jean McCown and several "Lifetimes of Achievement" award recipients.

Overall, Avenidas is doing well despite continuing "to ride out this very long economic storm."

The organization is doing particularly well in its "Avenidas Village" program that helps its 325 current enrollees remain in their homes by providing home-based support services. It is the second largest "village" program in the United States, and re-enrollment is running at about 95 percent, Henderson said.

Avenidas also is collaborating with the Palo Alto Medical Foundation on the new David Druker Center for Health System Information on redesigning health care for seniors, under a program headed by Dr. Paul Tang, a nationally recognized expert on computer-assisted health care.

But the day health program hurts. While the number of persons affected may be small in the large picture the depth of impacts is deep, on the individuals and their families.

The Kleiner center is located in its own building in the 200 block of Escuela Avenue in Mountain View but it is one of Avenidas' major programs.

The center serves a specific segment of the local population: frail elderly persons and their caregivers, usually family members. A staff of registered nurses, social workers, physical and speech therapists, dieticians and activity aides provide stimulation, health-supporting services in what is termed a "warm and nurturing environment" behind the rehabilitative services. There is even a cozy fireplace.

Every day, 60 or so quite elderly men and women are brought by van to the center for attention and care by trained professionals, for social contact and to provide respite for family or other caregivers. The half expected to remain in the program are self-funded, often with family support. Day health programs differ substantially from "senior day care" centers, which focus primarily on social and recreational activities. Such centers receive no state funds.

As of late June, this week, 20 senior day health programs statewide have shut down due to an impending loss of state MediCal funds, and the Palo Alto/Mountain View center is about the feel the strain of loss of MediCal funding. Governor Jerry Brown has signed off on the legislation that cuts the MediCal funds, about $175 million worth.

Some kind of "replacement benefit" is supposed to come from the state, "but we're not seeing much action on that at all." The federal government needs to approve the MediCal cut, which is a near certainty, Henderson reported.

"We expect it to be eliminated within 90 days," she said of MediCal funding, California's version of the federal MedicAid funding for the poor.

She is "doubtful there will be a replacement program in place" given the current state of the state.

And even if a program emerges, it would be funded at about $85 million, roughly half the current funding, according to John Sink, Avenidas' vice president for programs. Sink in the early 1980s headed the senior day health program when it was based at the Palo Alto Baptist Church in south Palo Alto and had about two dozen daily attendees.

There's a cruel twist to the day-health saga. The so-called replacement program is called by the acronym KAFI, which means "Keeping Adults Free from Institutions." Ironically that is the biggest benefit of senior day health programs from a taxpayers' perspective, as most clients of such programs would otherwise need to be put in a full-care institution.

Tracking the needs of seniors in the Palo Alto area has been a focus of Avenidas and the Senior Coordinating Council since before it became its own nonprofit organization. In the early 1960s Palo Alto created a half-time "senior services coordinator" position, provided an office in the Downtown Library and hired Diana Steeples.

Then the city commissioned a "senior needs survey," done by the late Queenie Amirian and the late Carol Bernhardt, in 1962. But city officials were fearful of doing more because of a concern voiced by some that Palo Alto would become a "magnet" for needy seniors from all over the Bay Area. Then an update of the needs survey circa 1966 disclosed that a large majority of seniors had lived in Palo Alto for more that 25 years.

This meant that most of the local seniors had spent much of their lives in the community, in both high-end jobs and lower-paying positions of store clerks, service-station attendants, and intermediate-pay jobs as teachers, public-safety employees, journalists and others.

I reported on the story for the Palo Alto Times as a young reporter fresh on the Palo Alto beat. Magically, it seemed, the old fears evaporated and the city moved toward creating a full-fledge senior coordinating agency to pull together disparate efforts. While many persons were involved, two stand out: Dr. Sid Mitchell of the Palo Alto Medical Clinic and Wesley "Bud" Hubbard, who rose to the city's "impossible" challenge of raising $1 million to qualify for occupancy of the 450 Bryant St. building.

Other needs studies were done in 1972, 1986 and 1997, augmenting and updating U.S. Census data. All showed a serious concern about access to health care and support services with advanced age and illness or physical or mental limitations. The 1986 survey in particular showed an acute concern about loneliness and isolation, in addition to accessibility and cost of health care and related services. No survey was done in the past decade due to prohibitively high costs.

"Avenidas" means "The Avenue." While some lanes may need narrowing it may take some real doing to keep programs from hitting a dead-end.

[Former Weekly Editor Jay Thorwaldson can be e-mailed at jthorwaldson@paweekly.com. Other blogs and columns can be accessed at www.PaloAltoOnline.com (below the Town Square forum) and in online archives of the Weekly.

Comments

Posted by Marie, a resident of ,
on Jun 29, 2011 at 9:19 pm

Marie is a registered user.

As a retired person, who wants to age in place, I am supportive of anything that will help me do it. However, per the website below, the average cost per day is $64.

Web Link

That seems really high and my guess is that the Palo Alto program is probably "above average." Avenidas does not state what the full unsubsidized charge is on its website that I could easily find. I also don't know what the state pays but I vaguely remember reading an article that it was in that range. If someone was in adult day care 5 days a week, 22 days a month, that would be over $1,400 a month which is more than low cost 24/7 hour living facilities (not nursing homes). Full price at Chai House in San Jose for a one bedroom is $1,211 per month. For $224 more, you get a monthly meal plan. The subsidized rate is less. Why is senior day care so expensive?

Sadly, it doesn't make sense for the state to pay more for adult day care than for 24/7
care. I have a relative who has a parent in an altzheimer unit, albeit in Stockton, for $1,200 a month, paid for by his social security and SSI. Sadly, in the kind of budget crisis we are in, unless they can reduce the cost of adult day care, it is cheaper to use those live-in facilities. My guess is senior day care programs pay their workers and administrators more than low cost assisted living centers and/or perhaps have higher administrative expenses since they are not 24/7. It is a conundrum.


Posted by Too bad, a resident of ,
on Jun 30, 2011 at 11:39 am

Marie: Extremely well said. I love Avenidas, but the reality is always about "bang for the buck", isn't it? And, we have to face reality, in a shrinking economy, there simply isn't as much buck to give a bang with.

However, how about private donations to help keep these places going? There are still a few folks with money left in the area, maybe there would be some kind donors willing to help out, as long as the costs could be pared down. What on earth is costing so much, I wonder? Seems worth a look


Posted by Avenidas, a resident of ,
on Jun 30, 2011 at 12:17 pm

It is great to see people talking about such an important issue, but some misperceptions should be clarified. People are mixing apples and oranges in their discussion here. There are two models of care: the social model, which is simply adult day care. Then there is the medical model, Adult Day Health Care, and that is the model that Avenidas Rose Kleiner Senior Day Health Center (SDHC) in Mountain View follows.

SDHC is a licensed Medi-Cal certified health facility that treats the health and supportive needs of older adults with multiple, chronic conditions in a safe, homelike day setting. The goal of SDHC is to prevent or delay placement into nursing homes or other more expensive care settings. This is done by improving and preserving each individual's physical and mental health, and improving their quality of life. Older adults with chronic conditions are able to successfully live in the community while a benefit for the caregiver is regular respite from 24-hour caregiving responsibility. SDHC provides many health and social services under one roof for one set daily fee. Persons attending SDHC are pre-approved by the Medi-Cal field office (if a Medi-Cal beneficiary). Non Medi-Cal participants pay out-of-pocket. The Avenidas Rose Kleiner Senior Day Health program uses a sliding scale for private pay participants, which ranges from $76. 27 to $125 per day.

SDHC participants attend, on average, 3 days per week. Many services and activities are offered based on a thorough assessment and plan of care. Services provided on an individual basis include nursing supervision and assistance, medication monitoring, physical therapy, occupational therapy, speech therapy, and social work. Assistance with daily tasks such as eating and walking are provided by trained program assistants. Group activities provide companionship and social stimulation and are designed with the participants level of ability and interests in mind. A noon meal, transportation to and from the center, caregiver support groups, community outreach and education and other services are also provided.

Generally, by having their frail and elderly loved ones attend Avenidas Rose Kleiner Senior Day Health Center, families can keep them out of nursing homes longer. These folks are not candidates for independent or assisted living—they would need to go to skilled nursing facilities, which are very costly.

Avenidas doesn't believe it is a good fiscal decision to cut Medi-Cal funds for this type of care because institutionalizing chronically ill older adults is much more costly and puts a heavier burden on the healthcare system.


Posted by Marie, a resident of ,
on Jul 1, 2011 at 6:59 pm

Marie is a registered user.

As an alternative to nursing homes, Avenidas' program makes sense. Does this mean this program can give medicines and do testing, like blood glucose tests, as nursing homes can?

At $125 a day (apparently full cost), that means approximately $15 an hour, which is probably less than most, but not all, private home health aides. I realize this is not apples to oranges as Avenidas provides a lot of services that a home health aide cannot, but the reverse is true as well. From the perspective of providing a break for caregivers, however, the two kinds of services are the same.

Aging in place is not a simple path but one I hope can be cost effective. Often it isn't. To end up in a nursing home when living at home is possible with extra resources is a tragedy.

I have mixed feelings about the medicaid part. If only those recipients who were eligible for a medicaid financed skilled nursing facilities qualified for medicaid assistance in senior adult day care, then I support it.

However, compared to assisted living facilities, it does not make sense. What would impress me more is if there was a social program available at a much lower cost than home health aides, for those who aren't ready for skilled nursing but whose caretakers still need a break.

My understanding from the website is that Avenidas is a 501(c)(3) nonprofit, which does have an endowment and does receive significant funds from private donations. However, my best guess is that it will be quite difficult to make up the medicaid funding from private donations alone. I hope someone is actually tracking whether the severe cuts in senior daycare does increase medicaid spending due to an increased number of people going to nursing homes. That would certainly be a great argument to get funding restored.


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