LOS ANGELES -- Earlier this month when Gov. Jerry Brown (D) announced cuts of $2.5 billion to health and human services programs, advocates for low-income, sick, elderly and disabled residents of Los Angeles County acknowledged that the first cuts are not always the deepest -- or most damaging.
"We are appalled," said Vanessa Aramayo, executive director of the California Partnership and co-chair of the Health and Human Service Network of California.
"Since 2008, California's health and human services have suffered an astounding $15 billion in cuts, and this budget only continues the gutting of the social safety net that so many Californian families depend on," Aramayo said in a prepared statement. "We must roll back the tide of continual cuts that target the same low-income and vulnerable Californians year after year."
L.A. County's low-income, at-risk seniors who are trying to stay in their homes rather than live in institutions must rely on a system of publicly supported programs that the UCLA Center for Health Policy Research has called "fragmented" and "often uncoordinated."
If Medi-Cal eligible seniors enter nursing homes or arrive at emergency departments and hospitals, taxpayers still foot the bill. And that bill is projected to increase, particularly as services to keep seniors at home decrease. Medi-Cal is California's Medicaid program.
Nationally, approximately 76 million baby boomers -- those born between 1946 and 1964 -- have begun to retire and clog an already strained health care system. California is home to at least nine million boomers.
UCLA's brief concluded that "as existing options for public support dwindle, it is uncertain whether these older adults -- and especially those who are the least resilient -- will be able to make do with even less."
Advocates Get Busy in Election Year
Gov. Brown's $92.6 billion budget proposal for fiscal year 2012-2013 includes deep cuts to health and human services programs. It calls for reductions to CalWORKS and Healthy Families -- California's Children's Health Insurance Program -- which would affect families and children. In addition, the governor proposes significant cuts to Medi-Cal and In-Home Supportive Services, which would affect seniors. Brown proposes to cut $163.8 million from IHSS by eliminating domestic assistance for beneficiaries in shared living environments. He proposes to cut $842.3 million from Medi-Cal by merging services for beneficiaries eligible for both Medi-Cal and Medicare.
These proposed cuts come on top of previous cuts which have left IHSS and another seniors program -- Adult Day Health Care -- shadows of their former selves. Cuts to both programs have been challenged in court.
A proposed 20% cut in IHSS services was halted by a federal judge earlier this month.
A lawsuit challenging the state's transition plan for beneficiaries of the ADHC program was settled out of court. The settlement will end the ADHC program on Feb. 29. On March 1, the Department of Health Care Services will establish the new, smaller, less-funded Community-Based Adult Services program.
The 25-member Los Angeles Aging Advocacy Coalition carries a torch for the county's 1.6 million seniors. The Coalition, which includes the local chapters of AARP and the Alzheimer's Association, is committed to a "unified voice," said its chair, Rigo Saborio. Saborio is also president and CEO of St. Barnabas Senior Services, the city's oldest senior services agency, serving 8,000 people annually.
The coalition will host its next education and advocacy forum in February. It's on a mission, said Saborio, "to shape policy and to support and/or defeat efforts that affect the interests of older adults." For instance, the group intends to back candidates in the 2012 election who are "champions of legislation who believe in and can truly support" aging issues in Los Angeles. From his standpoint, there are a few such lawmakers already, but more are needed.
Saborio has seen vital senior service provider programs eliminated or funding reduced, citing the Linkages (case management) Program, Alzheimer's Day Care Resource Centers, the Brown Bag (lunch) Program, the Multipurpose Senior Services Program and the Los Angeles Caregiver Resource Center.
"In my opinion, when you eliminate options for folks to find support and assistance, you'll see increased levels of emotional distress, depression, physical ailments and serious financial issues," said Saborio. "People, most of whom live alone, must often choose between medicine, buying food, paying rent, affording a piece of clothing, and then, there's the constant issue of lack of affordable housing. People need a life vest when they're given just 30 days to move."
Keeping Seniors at Home Expected To Become More Difficult
"The best tool to help keep people home is IHSS, a safe household and a willing caregiver. I'm afraid of what's going to happen in the next couple of months," said Janet Morris, elder law attorney at the not-for-profit Bet Tdezek Legal Services and director of its Family Caregiver Project. The organization advocates for Medi-Cal eligible clients to receive the "correct number of hours" through IHSS to help with feeding, bathing, client "transferring" and shopping.
"If you're really rich, you can pay for care, but if you're really poor, you get IHSS, which is now being diminished," Morris said. "But if a person is given 30 hours and they really need 200, they can't be cared for at home safely. If they can't get enough hours, they may be forced into a nursing home. They have a right under the law to receive the maximum hours."
Research has shown that clients who receive day care generally improve or maintain function, which in turn, helps keep them out of hospitals and nursing facilities.
The current financial crisis gets advocates "all fired up and brings us together to ensure people we serve have a voice when policies are made," said Mollie Davies, vice president for elder abuse prevention and ombudsman services at the not-for-profit agency WISE & Healthy Aging in Santa Monica.
"Cuts come at a time when we should be ramping up capability, we're doing the exact opposite in California," Davies said. "When we hear that 'an agency just lost staff,' the effect drills down much further to the clients."
Most clients receive IHSS while in WISE's Care Management program, said Davies. Half of those served are between ages 80 and 100, 70% have some kind of disability and almost all have a high degree of frailty.
"With reduced hours, we're seeing clients going without, especially those on the edge of needing longer-term placement in a nursing home," said Davies. "They struggle with low incomes, and with no family they have no chance and there's no turning back. They're there, alone, until the end."
'We're Not Spending Enough Money'
"It's not like we're spending too much money; we're not spending enough money," said Patricia McGinnis, executive director of the California Advocates for Nursing Home Reform. "There's more need than ever in this state. The failure to pass any revenue enhancements is ridiculous."
McGinnis is chagrined by a lack of any concerted effort to expand access to long-term care insurance in the state, a situation for which she blames insurance industry opposition.
"If they sold decent [long-term care] products, people would buy," McGinnis said. "Even those who bought policies 10 to 15 years ago find premiums have doubled. Then they have to fight to get benefits when they need them. Let's sit down and do a plan. We used to have wonderful long-term care support, but it's being decimated. If you don't have a family to take care of you, what are you going to do?"
The "age wave" is coming ashore in Los Angeles and is already testing the mettle of community services.
"Life happens -- accidents, and other unfortunate, unexpected incidents which spin one's comfortable life into chaos in a matter of seconds, and suddenly they are now dependent on the safety net system that is under siege," said Saborio.
He added, "In spite of the gloom, we don't give up hope, we'll stay in the game, keep chipping away, advocating on behalf of those in need because we believe that good things will come out of it."