Agencies consider future with senior services cuts
December 06, 2011 12:00 AM
The successful lawsuit by Disability Rights California and other groups to stop the state from eliminating funding for Adult Day Health Care Services, an optional benefit for poor and elderly citizens, has no direct impact on San Joaquin County.
There is no such facility, paid equally by Medicare and Medical, which provides medical care, physical therapy, exercise, counseling, socialization and other support to qualified adults, in the county. The only day care service of any type is Lodi's Adult Day Services Center at Hutchins Street Square, which serves those with Alzheimer's and dementia but is not licensed for medical care, or physical or speech therapy.
What the lawsuit - to restore funding in the state budget for the facilities that care for 37,000 people a day - does, though, is illustrate the potential state and federal budget cuts aimed at the senior population.
"Although we don't have a program, for me and our agency it sends a sign," said Dean Fujimoto, deputy director of aging and community services for San Joaquin County's Human Services Agency. "Although we know the state is in a budget crisis like most localities, this is an indication of the direction the state is headed, with proposed cuts to medical and other social aid programs, including programs directly affecting seniors."
The proposed state budget for 2012-13, Fujimoto said, will realign programs so that his agency's Adult Protective Services will be funded by the federal government and In-Home Support Services will be supported by the state.
"It fits into (2010 Affordable Care Act passed by Congress) and it's a clear indication by the federal government and the state of a move toward managed care programs," Fujimoto said. "That's the model. Our concern, at the local level, is there are specific local issues, and each county agency is better equipped for knowing the needs of the community."
That concern was repeatedly expressed at a Senior Health Policy Forum in San Francisco last week addressed by federal, state and Bay Area county representatives and attended by health care workers and other providers of senior services. Managed care health programs can take care of medical needs, service providers point out, but they may not be equipped to handle the social services seniors depend on, or provide the support services for families taking care of senior adults.
"The bottom line is that on the health care side of things you can justify dollars and cents as opposed to services," said Annette DePauli, unit chief for the San Joaquin Department of Aging. "The current social services model has you put money out to help people and hope it helps. In the health care model you can say you applied $400,000 here and got this many hours of service that prevented them from going to a nursing home and saved $1.5 million. It's more measurable. Managed care focuses on medically based needs and won't be attending to psychological, social and emotional caregiver needs. It will be medically focused. The danger is it will lose the humanness."
Drastic change appears to be coming to senior care, but the picture is hazy, colored in California by the recent fight to retain Adult Day Health Care facilities, which ended with those facilities not closing Dec. 1 as planned but remaining open though February 2012 and then shifting to Community-Based Adult Services on March 1.
"There are three things we can learn from the ADHC issue," Joanne Handy, the CEO of Aging Services of California, which represents nonprofit senior living facilities, said at the San Francisco event. "One is that the unthinkable can happen in this environment. Two, it showed when providers get together with consumers who benefit from the service, that it has an impact, and third, when people like Disabilities Rights Group, (California Association for Adult Day Cares) and scores of other human service organizations get together, we can make a difference."
Working together will be essential as agencies move forward to provide services in this fiscally frightening time. Human Services in San Joaquin County already partners with other agencies. Catholic Charities, for example, receives most of the agency's funding for in-home services.
Assistance from nonprofits won't just continue. The role of nonprofits will expand, Fujimoto said.
"I see grant applications that come out and I send them to staff and more times than not, we can't apply because we're a government agency," Fujimoto said. "You need to be a nonprofit agency to apply. If I can set up a nonprofit, whereby it's based on donations, we have some sort of board representative of the community and it's structured where the interest from donations, and not the principle, is allocated, we can offset county or federal or state cuts. It's tough for donors with the financial crisis. I'm a realist. I know I'm not going to set up a nonprofit and have some big donor come through. It will take work. In time it will benefit our agency as baby boomers age and those programs bridge the services we provide to keep them in their homes longer."
Keeping seniors out of institutional care as long as possible has been a federal objective since 1965.
"The Older American Act was passed for people to live in their homes with dignity as long as possible," DePauli said. "As a population, we voted on this, but it's slowly dwindling. The only way to survive is working with others in the community, knowing what others have and working together to fill the gaps. The county and nonprofits and organizations need to come together to survive and do the right thing in today's economy."
Services for seniors and their families continue to start with the Human Services Agency. A call to (209) 468-1104 or (800) 510-2020 is the place to start. A representative will evaluate an individual's situation, determine needed services and eligibility and direct him or her to the proper department or nonprofit group that can help.
Human Services Agency has extended its outreach not only to seniors but to the community at large by placing eligibility workers at two of its community centers with plans to place such workers at two additional centers in January and possibly all eight by July.
"Folks who need the services most but have transportation issues and might not be able to make it downtown can still have access to our service," Fujimoto said.
Funding cuts will continue to come, but his agency still has plans to reach out to those in need within the community and find a means to help them.
