State changes stance on adult centers

Ramona Adult Day Health Care Center “has been taken off the chopping block for right now,” said co-program director Haley Palmbach. But the news may not be as good as it sounds.

Trying to balance California’s debt-riddled budget, Gov. Arnold Schwarzenegger had proposed eliminating all adult day programs, like the Ramona center—a move that would save the state over $170 million. Now it appears that the programs will not be totally abolished, but will suffer deep cuts instead.

Right now the adults who need the most care are approved to be at a center for five days a week, Monday through Friday.

“We are hearing that no one will be approved for more than three days,” Palmbach said. “The five-day people are the ones who really need the care. This cut would be devastating for them and their families.

“It would make more sense to cut out those who only qualify for one or two days of care, because they don’t need as much help.”

This cut may force caregivers to place ailing loved ones in skilled nursing homes, which are “outrageously priced,” said Jean Busher, the Ramona center’s co-program director. Or the caregivers may have to work fewer hours so they can spend more time at home. And the center would be “in a really difficult situation” trying to maintain the same staffing levels with a reduced income.

The daily cost of someone at an adult day health care center is $76.27, but the state pays only $29.60 of this in Medi-Cal funds for clients who rely on the government to pay the bill. The federal government pays the rest. It can easily cost the state $5,000 to $8,000 a month for someone in a skilled nursing facility, Busher said.

“This is so frustrating,” Busher said. “Here the state is in a financial crisis with no money and the plan to resolve it is actually going to increase expenses. It’s unconscionable.

“It all boils down to a public perception of managing the budget rather than actually managing the budget. Officials can point to how much was cut and saved in one area without saying how much has been added in skilled nursing costs, not to mention the increased unemployment from caregivers who have to quit their jobs.”

One caregiver who really appreciates the five-day weekly service now offered by the Ramona center is James Tucker, co-owner of Ramona Motors on Main Street. Tucker is a single father with three children, aged 6, 10 and 13, and he also cares for his 75-year-old mother who has dementia and Alzheimer’s disease and needs full-time supervision.

Being able to drop his mother off at the center every weekday morning for the past year “has made a huge difference,” Tucker said. “They take better care of her during the day than I could, giving her physical and mental therapy and looking after her needs. By myself, it is all I can do to get her fed, washed and clothed, run my business and take care of the kids.”

If the center’s services are cut to only three days a week, Tucker’s solution is to place his mother in the Last Resort, a residential care facility on the same property as the center at 2138 San Vicente Road. He has actually begun the process of trying to get her into the facility, but there are no openings. He has no idea what he will do if the center goes to a three-day schedule before a bed becomes available at the Last Resort.

The Ramona center has more problems than its uncertain future.

“As of July 1, we will no longer get paid (for clients on the state Medi-Cal program),” Palmbach said. “We’ll get no money until the state budget is passed. Some facilities close down but we won’t. These people still need us.”

When state funds were cut off in the past by budget crises, centers survived by taking out small bank loans guaranteed by the state.

“But this time the state is not guaranteeing loans because they’re not sure which way they are going to go with the budget,” Busher said. “This is a real hardship, because these centers are not government- or state-run facilities. We are private, nonprofit, small family businesses without deep pockets to cover costs. We want to keep our employees, but they can’t make a mortgage or a car payment with an IOU.

“We are really getting hit at all levels. It’s a shame.”