It's budget week at the Capitol. A slew of legislative hearings will deal with the newest wave of cuts proposed by Gov. Jerry Brown (D), most of which are expected to be approved.
The argument against health-related cuts almost always follows two points: The human toll of denying services is high; and in the long run, those cuts don't actually save money. The reasoning is that health problems don't go away and until people die, their health issues usually become more acute -- and, in the long-term, more expensive.
In the case of adult day health care services, advocates say, the shift to higher-expense services has already started, and the state may not save any money, now or in the future, by cutting the $85 million needed to keep the program alive.
For instance, when the ADHC center in Sonora recently closed, that left 59 patients without care. The idea of ADHC is to offer services that allow seniors and the disabled to stay at home. Now many of them will not be able to live at home anymore, according to Carmen Reimer, former director of the Sierra LifeNet Adult Day Health Center in Sonora.
"We moved three people who needed immediate placement into nursing homes," Reimer said, "and I counted at least 10 people who needed to be in a nursing home."
That's expensive, according to Lydia Missaelides of California Association of Adult Day Services.
"You're looking at care that's 24/7 care, for 365 days a year. That costs a lot of money. When you're talking about people coming in part of the day for three days a week for adult day health care, that's a lot less expense."
In fact, she said, the general rule of thumb is that it's five times more costly to be in a nursing home. So just taking the Sonora example, she said, you're looking at 13 out of 59 patients who are bound for five-times-more-expensive nursing homes.
"Where's the cost savings in that?" she asked.
Last year, a nonpartisan Lewin Group study said the state would actually lose $51 million in the first year by cutting ADHC, and that number was projected to rise over time.
Given those statistics, the Legislature worked out a deal to keep the ADHC program running on half of its budget. For legal reasons, the program had to be terminated, and then restructured using a federal waiver. But now the state has no current plan to apply for that waiver. The latest budget contains $25 million for ADHC, to ease the transition into program elimination.
"Discharge planning for 37,000 adults is beyond our understanding right now," Missaelides said. The state's going to have an expensive end result in that discharge process, she predicted.
"It's been a confusing budget process," she said. "We did think there was a deal made at that time, that there had been an agreement reached. And we're disappointed we have to go back into this again, and we're gearing up to fight again."
Back in Sonora, Reimer said there's also cost to the state in terms of jobs. Her center had 10 employees, and also hired part-time physical therapists, food and transportation services.
"We officially closed the doors on April 29, and that's one of the most heart-wrenching things I've ever been a part of," Reimer said. "This idea that there are other things out there to take care of our folks is really a farce. There will be no case management for these folks. There are no programs offering them physical therapy so they can cook an evening meal for themselves, or be able to open a car door. This [closure] sent them into a tailspin."
In a small place like Sonora, in Tuolomne County, losing the ADHC center creates a ripple effect, Reimer said.
"This is very discouraging for our folks," she said. "We have a very high unemployment rate in Toulomne County, and we just added to it. This affected a lot of people here."