In their mid-80s and beset by Alzheimer’s disease and two types of cancer, respectively, Jewish Russian immigrants Dina and Isaak Freylikhman of San Francisco consider themselves blessed that the L’Chaim Adult Day Health Center exists.
Three times a week, a shuttle picks them up at their Richmond District apartment — where they live on their own — and takes them on a 15-minute ride to the center, where they receive a battery of medical and therapeutic services, and even get to go on supervised walks in Golden Gate Park.
“My wife uses a walker, so she needs the help,” Isaak, 86, a native of Ukraine, said in Russian. “And I feel comfortable that if something goes wrong, the attendant will be able to give us help or call an ambulance. I love this program. I love keeping my independence.”
However, the Freylikhmans and thousands of other Californians like them are in danger of losing that ability to live on their own. If the state Legislature approves Gov. Jerry Brown’s proposal to cut $1.7 billion from Medi-Cal, some $486 million for more than 300 Adult Day Health Care programs in the state would be eliminated.
L’Chaim, a program of the S.F.-based Jewish Family and Children’s Services, and all other ADHC programs that serve low-income, medically at-risk seniors would have to shut down, said Anita Friedman, JFCS executive director. ADHC programs get 85 to 90 percent of their funding from state funds and $200 million in matching federal funds, Friedman said.
The Medi-Cal cut, part of Brown’s plan to narrow the state’s $25.4 billion deficit with $12.5 billion in overall spending cuts, would also wipe out the Multipurpose Senior Services Program, which includes a JFCS-run program that serves 85 seniors in Marin County. MSSP currently is funded for $19.9 million and serves some 12,000 disabled or chronically ill seniors each month statewide.
But the elimination of ADHC and MSSP won’t save the state bottom-line dollars, Friedman and other senior health experts contend.
Brown’s estimated savings would be wiped out if only one in five people in the program were forced into a nursing home, Nancy Masters, who oversees the JFCS Marin County office, told the Marin Independent Journal.
Worse yet, according to JFCS documents, it is estimated that a whopping
72 percent of clients would enter nursing facilities within six months of ADHC and MSSP elimination. “All of the people in [these programs] have already met the criteria for Medi-Cal to pay for a nursing home,” Master explained to the paper.
“These are not budget cuts, they are cross-shifts,” Friedman said. “We can take care of people in their own homes, and bring them to medical clinics three times a week to make sure they’re taking their medications, eating properly and are in good physical shape. That costs about $15,000 per person a year. Or you can take the same person and put him in a government-funded hospital for $45,000 a year.
“So it’s in the best interest of the state to have a good system of lowest cost care, rather than institutionalize people at much more cost.”
To that end, Friedman and dozens of other senior-health care managers from throughout the state went to Sacramento last week to plead their case to the budget subcommittee on Health and Human Services. Rookie Assemblywoman Holly Mitchell chaired the meeting, and within 48 hours of Brown’s initial budget cut announcement, she had an 8-inch stack of documents and letters, many of them complaining about the cuts.
And that’s just the tip of the lobbying iceberg, Friedman said, noting that a 100-member-strong JFCS advocacy and public issues committee has swung into action, sending letters, faxes and e-mails.
“It’s not that we don’t understand that the state is in a crisis and [needs] to cut expenses,” Friedman said. “Our interest is in helping the decision-makers make excellent decisions. It’s not a good business decision to cut out a lower-cost solution and choose a higher-cost option. And there’s also the humanitarian element. Government has always been in the role of caring for the poor and vulnerable.”
The L’Chaim center annually serves 300 clients, most from the Russian-speaking Jewish community in San Francisco; the average age of clients is 85, and they have average monthly incomes of less than $900. Clients have to qualify through Medi-Cal, the state’s health insurance program, and services include skilled nursing, mental health care, social work assistance, physical, occupational and speech therapy, medication management, dietary services and transportation. MSSP programs are similar.
Friedman noted that the ADHC and MSSP are “safety-net programs for poor and frail people that don’t have any other resources,” not for “people who have money and family help.”
Avi Rose, executive director of JFCS of the East Bay, said that although his agency doesn’t operate any ADHC or MSSP programs, “the general prospect of service cuts is likely to have a major impact on many of our clients.”
At the Jewish Home of San Francisco, Daniel Ruth, the president and CEO, said Brown’s 2011-12 proposed budget also calls for a 10 percent reduction in hospital-based skilled nursing reimbursement from Medi-Cal, which would “significantly impact the Jewish Home.” His facility serves 430 people annually (80 to 85 percent on Medi-Cal, he noted) and is the third-largest nursing home in the state.
Another assisted-living facility, the Reutlinger Community for Jewish Living in Danville, is in the same boat, said Dr. Janice Corran, executive director, “as up to 30 percent of our skilled nursing residents are funded by Medi-Cal.”
Ruth said slashing the skilled-nursing reimbursement would cost the Jewish Home $4 million to $6 million per year, “and we’ve already been under significant financial pressure the last three to five years.”
The state has already tried to slash the nursing reimbursement twice, failing both times after legal challenges from the California Hospital Association, and the matter is still tied up in the courts.
On the other hand, the proposed cuts to the ADHC and MSSP programs are on the “fast track because of the budget crisis,” Friedman said. The governor has said he wants to get a budget back from the Legislature by March.
Brown also wants the Legislature to approve a special election in June asking voters to extend tax increases, but whether voters go to the ballot or box or not won’t have any affect on the already proposed first round of cuts, Friedman said. That’s why she and others are trying as fast as they can to help legislators “understand the complexities” of the proposed Medi-Cal budget cuts.
In the meantime, the Freylikhmans have their fingers crossed. With their only child living 800 miles away in Vancouver, they rely on L’Chaim for a multitude of services: Isaak, who is getting outpatient chemotherapy treatments from UCSF, for nursing care, medical tests and exercise classes; Dina, who has Alzheimer’s and has lost her ability to talk, for speech therapy and other care.
In addition to spending 13 or 14 hours at L’Chaim each week, they also receive about 4.5 hours per day of in-home care, and although that doesn’t come from JFCS, it is a service that also might be on the cutting block.
Isaak relishes the independence that L’Chaim and other social-service agencies allow him and his wife to maintain, but it’s much more than that, he said. He also likes going to L’Chaim to socialize.
“I’m receiving all of the Jewish cultural life that I was not able to participate in in the former Soviet Union,” he said. “[L’Chaim] celebrates all the American holidays and Jewish holidays, and I feel like I have a normal life.”