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Adult Day Care's Days May Be Numbered Under State Budget

Emily Frost |
April 27, 2011 | 8:11 p.m. PDT

Staff Reporter

Marcelina Cosico is going to be 90 this July. Her life has felt steady and pleasant this past decade, but all that could change in a matter of months. She sits at the head of a long table, surrounded by five women. They know each other very well, she says, because they always sit at the same tables. She’s been coming here, 2nd Century Adult Day Health Center, for eight years. They’ve finished breakfast, and will now listen to the news, read by a buoyant staff member. 

Marcelina Cosico is going to be 90 this July
Marcelina Cosico is going to be 90 this July

The center is a boxy, two-story building, on Beverly Boulevard in Filipinotown not far from downtown Los Angeles. Most of the day’s activities happen in the large back room, where the seniors, 95 percent of whom are Filipino, sit together, chatting, playing, exercising and eating.

The participants of this publicly funded center, one of California’s 300 or so elder daycares for low-income seniors, are by and large upbeat and friendly. If they know about California’s budgetary decision to slash ADHC funding in half, they don’t show it.

Medicaid pays the center $75 a day for Marcelina to come here; a cost far lower than what a home worker or a nursing home would charge the state.

“You have some jokes – so many things. You have so many friends around. I know everybody.”

In contrast to the camaraderie of the center, no one lives with her at her nearby home.

“I have no companion in the house and my daughter wants me to be active. Because if I stay home, I will have nothing to do but watch TV.” She chuckles, producing the slight rumbling of a latent cough.

Her house used to be filled with people. She moved to the U.S. from the Philippines in 1975, and then sponsored her 11 children.

“It’s very tiring to always be sitting and watching TV only. Here, you learn so many things. You enjoy the company of your friends. I don’t dance, but I watch people dancing here.”

Marcelina uses a walker to get around, but she’ll engage in as much activity as she can –seated arm and leg lifts – just not line-dancing.

She and others spoke proudly of the choice to come to 2nd Century. It’s as though by coming here to exercise and do activities, the 100 or so seniors had joined a special club of older people who look after themselves, who care about being social and getting out. Adult children or doctors may have been the ones to recommend coming to the center, but that doesn’t take away the feeling of agency the center cultivates. The participants check themselves in and then they return home by mid-afternoon – reestablishing their connection with the outside world and the sense of independence.

“We see each other and we see how old we are. Still, we are coming to the center!” said Isabelle Segedeo, a small woman with glasses and a shock of white curly hair.

Her favorite time at the center? “Any day!”

Monica Tan sits next to Isabelle. She echoes the overwhelming gratitude for how the center offers a break from the usual. “There’s nothing to do at home, you know. I cannot do washing; somebody washes my clothes. I don’t clean my house; somebody will do it. There’s nothing to do!”

At nighttime, many are alone. Some, like Thomas and Lenoida Festin, have a daughter who lives nearby and takes care of them and fixes them dinner. They need more help after Thomas’s stroke; he now uses a walker.

Monica leans toward the Festins. “They’re very lucky, because they’re still alive together. They love each other.”

Lenoida agreed. “Fifty-six years together. Six children.” They are from different provinces in the Philippines – “she is from the North, I am from the South,” said Thomas – but they were born only a week apart in the same year: 1929.

In the beginning

One of the center’s three vans, two SUVs or bus pull up at each house sometime between 6 and 7 a.m. “For free,” Isabelle boasted. “Come here for breakfast and lunch, all free. And that’s why we come so much, because we have somewhere to go to enjoy ourselves - with free everything.” She chuckles with happiness.

But the new budget for adult health care centers, $86 million, will most likely mean stricter eligibility criteria for the care, predicts Lydia Missaelides, executive director of the California Association of Adult Day Services.

This group of friends may be disbanded.

The concept of a day hospital started in England as a cost-saving measure to bring together services outside a regular hospital. In the 1970s the idea crossed the pond, with pilot projects starting in California. The model of adult day healthcare became law as a Medicaid benefit in California. Programs can be found in every state (except West Virginia, for technical reasons). Every dollar that California budgets for ADHC, the federal government matches.

Now, Adult Day Healthcare’s budget has not only been cut more than in half, from $176 million to $86 million, but it’s no longer a Medicaid benefit. The program will use federal funding called a federal waiver that will serve only those at the highest level of need – a smaller population.

“The ideal situation that we’re working towards is that the minute the adult day health care program stops being reimbursed as a regular benefit, it will begin to be reimbursed as a waiver benefit,” said Missaelides.

In other words, she’d like there to be no time gap in which programs do not receive funding. She also hopes it’s a change that’s invisible to patients – at least those who remain eligible for services.

However, Missaelides fears that “a number of patients will have to be discharged, and significantly, we believe that a number of centers across the state will close their doors.”

There’s a great deal of uncertainty ahead for both the centers and patients. The waiver payment system means the state has more flexibility in limiting the benefit and thereby limiting the cost.

“As a Medicaid benefit, that benefit is looked at as an entitlement. If you qualify for it, then you have access to it. But under a waiver, there are other rules that say that states may cap the number of patients that can be served under that benefit. There can be waiting lists created. The state can select only certain parts of the state, only certain counties that would have that benefit.”

The boss is worried

Alekx Gaiyan bought 2nd Century Adult Day Health Center six years ago. He’s very anxious about the future of his center, but can’t help talking about it – circling continually back to the subject.

He’s a reserved man, clearly overworked; his office strewn with hours and hours of paperwork. But he makes time to circulate in the big room downstairs.

“Those are the people who appreciate whatever you do. Not only me, all my staff,” he said of the seniors.

He allows himself a moment, a long sigh.

“I got a lot of loans behind my back, that’s why I’m in shock when I hear the news. I can lose my house, everything I put up for all these years. It’s a tough situation. Hopefully it won’t happen.”

But he hasn’t been sitting back. Gaiyan went to meetings with other owners, sent letters to the statehouse, collected signatures.

“We agree with the cuts – but not this kind of cut.”

The problem is his employees are professionals – social workers, dieticians, nurses, occupational therapists –not minimum wage workers. And Gaiyan doesn’t see where he can cut; his participants need these services.

“To tell the truth, I don’t even want to think about it. I’m praying every day that we can get a good, fair decision from the governor’s office.”

Closing the centers will ultimately cost the state more money, Gaiyan believes, because he’s keeping seniors out of the hospital system. He’s preventing emergencies daily.

“We’re there for them.”

Gaiyan holds up his hands – the topic of the future surfaces again.

“I know I’m going to lose big time. The bank will take away the house. We got a lot of credit cards that need to be paid. Business expenses. It’s a tough situation. And a lot of contracts. I recently signed a five-year lease with this building. We’re gonna get sued left and right.”

He took a lot of seniors to a protest in Glendale. Some of the media showed up, but it didn’t seem to make a difference to Sacramento.

“We work so hard. A lot of legislators don’t even know how the program works. Sometimes I want to call them in and show them what we do. It’s not easy what we do. There are a lot of older people, who cannot walk, a lot of them cannot speak… you just got to clean up after them, take care of them… it’s a lot of work.”

He comes in on the weekends to complete paperwork. It doesn’t stop, he says.

Gaiyan hopes the federal government will hold the state accountable – but he’s not sure. Any delay in the daily payment he receives for each senior to attend the center, will hurt his business too much; he’ll have to close. And then, he wonders, where will the 25 staff members go? Where will the 110 seniors go?

Marking time with birthdays

A xylophone-like chime signals the transition to a new activity. It’s group exercise time. Repetitive, beat-driven ‘80s music thrums in the background as a young man energetically shouts, “Head to the side. One…two…three…” and the participants echo his call. The staff has cleared away some tables so that the exercisers can sit together in the center of the room. Nurses sit at desk along the sides of the wall. They’re in the midst of going through checklists of patients who need their blood sugar and blood pressure checked.

As the days pass and the state makes it clear how the new arrangement will work, the seniors at 2nd Century are also eyeing the calendar – but for a different reason. If you’re a member of the 2nd Century community or staff, then you know that the monthly birthday party is a major event. All the birthdays of the past 30 days are celebrated.

Mary Menecian is a dietician who has a lot of fun working with the largely Filipino community.

“They’re very jolly people. They dance, they do parties.”

And on party days, the dress code is different.

“They dress to kill, they just love that. They do makeup. Their nails are done. They’re motivation to us. They’re great line dancers. And they love the chicken dance. ”

Unfortunately, Menecian said, “We cannot have parties all the time.”

Menecian said the guidelines will be stricter for who qualifies, but she doesn’t think she’ll lose her job.

Marcelina Cosico is expecting to celebrate her 90th birthday at the center in July – in true 2nd Century fashion – perhaps even wearing dollar bills, a Filipino custom; but by July, there’s a chance she’ll be attending the center’s farewell party.

This report is part of our special series, California in Crisis, which explores the personal, local ramifications of the state budget debacle. Please click here for more.

Reach Emily Frost here



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