Families face harsh choices if California’s adult day centers close
Santiago Chavarria, 89 , center, lifts his leg in an exercise class Tuesday at Yolo Adult Day Health Center in Woodland. His daughter-in-law Susan Chavarria says she'd have to quit her job or put him in a nursing home if the center he calls "school" were to close. The retired farmworker, who lives with his son and daughter-in-law in Knights Landing, suffers from heart disease and Alzheimer's.
The state's red ink has become personal for the Chavarria family of Knights Landing, whose patriarch, Santiago, could easily end up in a nursing home if Medi-Cal funding for his adult day health center gets chopped.
And for Davis resident Wilean Ruff. She worries that without being able to send her husband, Jerry, to adult day health, she'll have to quit her job two years shy of full retirement, a move that would affect her finances for the rest of her life.
At issue are looming cuts to the Medi-Cal program, which have put California's 327 licensed adult day health centers in danger. By March 1, in an effort to cut $134 million from the budget, the governor has proposed eliminating the Medi-Cal reimbursement to adult day health providers. Most of those programs would close as a result.
The nonpartisan Legislative Analyst's Office has recommended that the state Legislature adopt the proposal, even though doing so would lead to some adult day health clients enrolling instead in the embattled In-Home Supportive Services program.
Advocates have denounced the proposal as a budgetary shell game, and disability rights groups filed suit last fall over previous attempts to tighten adult day health eligibility requirements and limit services to three days a week.
"You can see why our beneficiaries are anxious and confused and scared," said Lydia Missaelides, California Association for Adult Day Services executive director. "Either an individual could lose their services or the whole program could be eliminated."
At 89, Santiago Chavarria suffers from more than a half-dozen maladies, including Alz- heimer's and severe coronary artery disease. The former farmworker, who lives with his son and daughter-in-law in rural Yolo County, spends weekdays at what he calls "school," the Yolo Adult Day Health Center in Woodland.
The center provides skilled nursing services – among them, medication management, wound care and ongoing medical treatment – as well as physical and speech therapy for 84 frail and elderly Yolo County clients dealing with chronic, debilitating health issues.
Without the center, Chavarria's daughter-in-law, Susan, says, he requires round-the-clock monitoring to make sure he doesn't wander off. He refuses to take his 15 medications. He'll eat food straight from the freezer, still frozen solid.
"When he doesn't get his way, he hits. He spits. He screams," said Susan Chavarria, a registered nurse. "We call them tantrums. He has such paranoia. He'll take snippets of things, and he'll go off into this world where we don't know where he is.
"This is why we can't take care of him 24 hours a day. It's too much."
For Susan Chavarria and her husband, Alex, a tree-trimmer, the program's proposed elimination isn't about the ongoing negotiations between the governor and the Legislature over the budget.
It's about the future: theirs and Santiago's.
"If he can't come to the center, I either have to quit work to take care of him, or he goes to a nursing home that takes Medi-Cal," Susan Chavarria said. "He doesn't have the funds to pay for assisted living. Truly, he'd be in a nursing home."
Missaelides says that would cost the state much more than cutting the program would save – $221 million in Medi-Cal reimbursements to skilled nursing centers and emergency rooms for some 37,000 clients displaced from adult day health programs.
More than that, she says, the loss of 7,600 adult day health jobs could cost the state $94 million in unemployment insurance.
The Yolo Adult Day Health Center would likely close without continued Medi-Cal funding, which covers 70 percent of its clients, said program manager Dawn Myers Purkey.
Jerry Ruff, 72, a retired UC Davis Veterinary School animal technician who suffers from dementia, isn't a Medi-Cal recipient. His wife of 43 years, Wilean, a kindergarten teacher, pays almost $2,000 a month on her own for his care – $1,210 to the Yolo Adult Day Health program and the rest to a private attendant who helps Jerry board the center's bus after she leaves for school.
She wouldn't be able to afford full-time private care for him, she says.
"If I can't send him to the center, I'll have to quit work immediately," said Ruff. "I won't have a choice. I'll be forced to immediately retire.
"I'm so afraid."
Santiago Chavarria checks out Carol Tam's pet rat. Yolo Adult Day Health Center provides health care and daily activities for patients old and young.
Santiago Chavarria gets ready to take a nap after his daughter-in-law Susan Chavarria, right, tucks him in at home in Knights Landing. The state's adult day program is also a lifeline for Wilean Ruff of Davis, who says she'll have to quit her job two years shy of full retirement if she has to care for her husband, Jerry, at home – a move that would hurt her financially for the rest of her life. "I won't have a choice," says Ruff, whose husband has dementia. "I'll be forced to immediately retire. I'm so afraid."
Activity assistant Rebecca Culverson, left, helps Santiago Chavarria play dominoes with his 73-year-old brother, Eduardo, right, at Yolo Adult Day Health Center. Program cuts could eliminate 7,600 jobs as well as shifting 37,000 clients to nursing homes or the state's in-home care program.
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