“Might as well have them walk the plank” — Cuts may force many seniors into nursing homes

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By Barbara Feder Ostrov, Cal Matters, May 19 2020

 Linda Jacobs, 71, at her home in Concord. Jacobs, who is at especially high risk for COVID-19 due to a number of health conditions including diabetes, asthma and heart disease, relies on the Multipurpose Senior Services Program to continue living independently. Photo by Anne Wernikoff for CalMatters

Linda Jacobs worked for non-profit organizations in California for years, including directing a substance abuse program for women. She never made much money. Now, Jacob lives off her monthly Social Security checks, and at 71, she suffers from many health problems, among them diabetes, asthma, heart disease and arthritis.  

The one thing keeping her out of a nursing home, she believes, is a state program inelegantly named the Multipurpose Senior Services Program, or MSSP. The program serves more than 11,000 people like her – people who are older, medically fragile and at real risk of being institutionalized in a skilled nursing facility. Every month, a social worker visits Jacobs at her mobile home in Concord to assess her needs, making sure she has enough food, arranging transportation for doctor visits, installing grab bars in her bathroom to prevent falls, even providing an emergency kit. 

Grim pandemic-fueled cuts to California’s state budget could shutter Jacobs’ program as early as July — along with another adult day health program that supporters say also has helped keep thousands of low-income seniors out of expensive nursing homes. 

Gov. Gavin Newsom’s revised budget, which must be approved by state lawmakers, eliminates that program and another one called Community-Based Adult Services, in which seniors go to adult day health programs for medical care, physical therapy, meals and socialization. These programs, paid for by Medi-Cal, California’s Medicaid program, are considered by the federal government to be optional. In contrast, Medi-Cal must pay for nursing home care for those who qualify for it; those benefits can’t be cut to trim the state budget.

Together, the two senior health programs serve nearly 46,000 of California’s poorest and most medically frail seniors in their homes or at one of 260 adult day health centers around the state. 

Eliminating them could save the state about $410 million over the next two budget years — but health advocates say that could force thousands of seniors into skilled nursing facilities in the middle of a pandemic.   

The novel coronavirus has raced through nursing homes with devastating speed. More than 4,800 California skilled nursing facility residents have contracted COVID-19, and nearly 850 have died as of May 19, according to California Department of Public Health data

“You might as well have them walk the plank,” said Barbara Porter, site director for the Multipurpose Senior Services Program in Contra Costa county, which serves 160 seniors, including Linda Jacobs.

Porter and other local program staffers say they were blindsided by the proposed budget cuts from a governor who last year called for a new state “master plan for aging” by this October. Porter said the MSSP program costs no more than $5,000 per client per year, compared to the roughly $40,600 per year that Medi-Cal would pay for a typical patient to live in a skilled nursing facility, though costs can be significantly higher. 

“Everyone’s in a state of shock about this,” Porter said. “What our program costs is budget dust, but it totally saves so many (seniors) from premature hospitalization and an institutional, end-of-life nursing environment.”

California, like other states, has long experimented with state-subsidized programs that offer social services and health care coordination to keep seniors independent and living in their communities, rather than institutions. The senior health programs now slated for elimination also faced the ax more than a decade ago amid budget cuts during the Great Recession. But consumer advocates filed a federal class action lawsuit against California to restore them and won in 2011, with some changes to the programs. 

It’s too soon to know whether another lawsuit will be filed, said Debbie Toth, president and CEO of Choice in Aging, a nonprofit that offers adult day health services to 320 seniors in Contra Costa, Napa and Solano counties. She and other program leaders had to quickly pivot at the beginning of the pandemic to provide services remotely to seniors who once had shown up daily at the centers. They then had to close following the state’s stay-at-home order.

If California’s senior budget cuts take effect, Choice in Aging “would lose about 80 percent of our programs and services,” Toth said. “It would devastate our organization that’s been around for 70 years.” At least 15 people could lose their jobs, Toth said, along with hundreds of other social workers, nurses, occupational therapists and physical therapists at the many adult day health programs across the state. 

Advocates for the programs say keeping seniors out of nursing homes is better for their well-being and more cost-effective than institutionalizing them. 

But California’s adult day health program also has drawn scrutiny from federal officials. A Health and Human Services Inspector General’s report released in September found that the state needed to more closely monitor the adult day program sites. The report noted that 23 of 24 sites where it conducted unannounced inspections had violations including improper storage of patient medicines, poor record keeping, and even in a few cases rodent and bug droppings. California officials, in response to the audit, agreed with the findings and said they had stepped up inspections and training for program staff. 

Maryam Davis said she has no idea what she’ll do if her 86-year-old mother, Nosrat Akbari, can no longer attend her adult day health center in Walnut Creek. Akbari lives in a low-income senior community in the city, where many residents boarded a daily bus to the program run by Choice in Aging before the pandemic. 

Davis, who lives in Los Angeles, said the program’s social workers gave her mother an emergency alert button on a necklace that may have saved her life when she fell late last year in her bathroom, breaking numerous bones. 

After Akbari was able to return to her apartment after a hospital stay, the program helped her obtain a hospital bed, a walker and other equipment she needed to recover at home, Davis said. Davis’ sister, who lives in the area, had cared for their mother until her health worsened. 

“She’s one of the sweetest grandmas but she has so many medical issues, and my sister couldn’t be there 24/7,” Davis said. “I was shocked, saddened and really concerned that they may cut this program,” said Davis. “It has given my mother dignity. She has so much life in her.” 

Linda Jacobs, the 71-year-old Concord woman, also fears for her future. Her daughter is disabled and her sons don’t live in the area, so they can’t provide the help she needs, she said. 

“The last thing I want to do is be in a nursing home, especially with the virus,” Jacobs said. “I worked hard all my life, and now I’m in a position where I really rely on other people, and that’s not the easiest thing for me.

“My social workers have helped me out greatly. They’ve been really, really kind to me. If I lose that, I don’t know what I’m going to do.”