A fixture in town for 26 years, the Ramona Adult Day Health Care Center on San Vicente Road will be forced to close its doors if Gov. Arnold Schwarzenegger has his way.
As part of the governor’s proposed budget cuts to Medi-Cal, all adult day health care centers in the state would be eliminated. In San Diego County, there are 22 such centers, like the one in Ramona, serving 3,182 seniors and disabled adults. Statewide, it is estimated that 36,000 persons benefit.
“The first proposal was to open the centers only three days a week, but when that was not well received by the public, it was decided to eliminate the whole program,” said Jean Busher, co-program director of the Ramona center.
The adult day care center concept began to flourish during the Reagan years. The idea was to move the elderly in need of care out of nursing homes and other large institutions so they could live in their communities, with the services they need. The centers became a place where caregivers could drop off their ailing parents or spouses for the day so they could go to work.
“Shutting down the centers is the polar opposite and will force us to reinstitutionalize the elderly in skilled nursing centers and other facilities,” Busher said.
“It makes us sick. We’ve worked so long to keep these folks out of nursing homes and now they’re going to have to go back in,” said co-program director Haley Palmbach, whose mother, Karen Cullen, opened the center in 1983 to have a place for her aging husband.
“I am so disgusted,” Palmbach said. “This puts so much responsibility on the seniors’ children, and the seniors have no voice about what happens to them in their golden years. And remember, a lot of us are getting older, too.”
Palmbach has worked with her mother at the center almost from day one, starting at age 18 as the activity director. She has been the program director for about 10 years, job sharing with Busher for the past year.
“This has been a real family affair; we live and breathe this. My sons help here, too,” Palmbach said. “My mother has worked too hard on this to have to sit and watch it die.”
Emotions aside, Busher offers compelling evidence that it is not in the state’s best financial interest to close the adult centers.
“It costs $76.27 a day for each adult at a center,” Busher explained. “The state pays 38.8 percent of this through Medi-Cal, or only $29.60, while the federal government picks up the rest. For every person who has to be placed in a skilled nursing facility, it will cost the state $150 a day, plus add-on daily fees for services that are included at the adult centers.”
These extra daily charges that the state would have to pay for services rendered include: $125 for medical supervision, $68.84 for physical therapy, $71.36 for occupational therapy, $78.43 for speech therapy, $8.40 for every 14 minutes of social services, $51 for psychological counseling and $33.48 for nutritional counseling.
“We are the bargain of the century,” Busher said. “Our nonprofit center provides all of that at no additional charge. Closing the adult centers makes no fiscal sense.”
If the federal government continues to provide funds for adult day care centers, would it be an option to get the state’s share—the $29.60 a day—from those using the centers?
“No, most of our clients are on Medi-Cal and are just scraping by,” Palmbach said. “We distribute food to them because a lot have nothing.”
In an effort to get their voice heard by state legislators, representatives of the Ramona center and other providers from the California Association for Adult Day Services have contacted the office of State Senate Republican leader Dennis Hollingsworth, whose district includes Ramona. Last week 14 members of the association presented their case to Jerry VanDeWeghe, district director of Hollingsworth’s El Cajon office, in three separate sessions.
“Our meeting seemed to go fairly well,” Busher said.
She felt that “it seemed to get his attention” that closing the centers would leave 655 people unemployed in San Diego County, including 17 in Ramona. “And then there are the adult children who will have to stop working and stay home to care for mom and dad.”
“But it all boils down to politics,” Busher said. “California is so big that these issues get lost. We don’t have a big lobby force. We’re very small compared to anything else. We’re not like big tobacco or big guns who can buy our way in.
“It’s a real struggle, but we’re trying to educate people about the misguided perception in Sacramento that this cut is going to save money. Actually it’s going to cost a lot more than it will save. It’s crazy.”
Palmbach is a bit encouraged by the fact that Ellen Malin, a field representative in Hollingsworth’s El Cajon office, has expressed an interest in touring the Ramona center. However, nothing firm has been set up to date.
Should the Ramona center be forced to close, a residential care facility on the same property at 2138 San Vicente Road, called the Last Resort, will not be affected. Both establishments are owned by Ramona Senior Care, a nonprofit corporation still run by Cullen, who serves as the administrator.
But the 54 senior and disabled Ramonans who are enrolled in the day care center “will be left to survive on their own,” Palmbach said. “It’s a crime to even think about closing these centers to save money.”