More than expected qualify for adult day health program
San Diego Union Tribune

Far more low-income ailing seniors and disabled adults than expected will be eligible to stay in California’s revamped Adult Day Health Centers program, offering relief to participants worried they could be dropped from the rolls by March 1.

But the numbers also indicate the program overhaul, meant to save the state $28 million this year and $90 million next year in Medi-Cal costs, could have far less budget-cutting punch.

One thing is clear: State officials overestimated when they predicted last summer that half of the 35,000 people attending 270 centers statewide — and 22 centers in San Diego County — would be disqualified as not medically precarious enough for the retooled program.

“We’re thinking it will be closer to 75 percent” remaining in the program this year, Jane Ogle, deputy director for health care delivery systems in the state Department of Health Care Services, said Tuesday.

But by next year, she said she expects the numbers to drop to 20,000 participants — low enough so the $85 million budgeted will cover the program that has cost $171 million a year, she said.

Adult Day Health Centers provide medical and social services to help participants living at home to avoid hospitalizations or the costly option of a nursing home.

The state had originally planned to eliminate Medi-Cal funding to the centers. But in November, a settlement in a lawsuit over the issue called for creating a new system by March 1. Under the new program, called Community-Based Adult Services or CBAS, the same services will be provided to Medi-Cal recipients who meet specific criteria. In the last month, 200 state nurses have visited the centers to evaluate all Medi-Cal participants.

Many center operators worry that in the scramble, needy people are being dropped from the new program.

“I think this has been a complete waste of money and time,” she said. “It just goes to show this is a real need in the community.”

Most San Diego centers are still awaiting final tallies, but the half dozen centers with the results say 80 percent to 90 percent of participants qualify for continued care.

At Glenner Alzheimer’s Family Centers in Chula Vista and Encinitas, all Medi-Cal recipients were approved, program director Dawn DeStefani said.

At Neighborhood House Adult Day Health Care Center in southeast San Diego, about 90 percent qualified, director Jennifer Hurlow-Paonessa said.

That pattern held true among Medi-Cal recipients at Redwood Elderlink in Escondido, director Kurt Norden said.

At Loving Care, Kintz said all but 14 of the 140 Medi-Cal participants in her program are eligible to stay.

To be sure, the future is uncertain for those who will be dropped from the program in two weeks.

“I was destroyed,” said Boris Flitsian, weeping as he described the letter delivered Friday informing him that Medi-Cal won’t pay for him and his wife, Solomeya, to come to the center after Feb. 29.

“This country that opened its arms to us, this place that takes care of us and helps us to be independent — why are they taking this away?” he asked, speaking in the careful English he’s learned since the frail couple emigrated from Russia in 1991 after the collapse of the Soviet Union and a new rise of anti-Semitism in their native Romania.

Both now 84 and dealing with numerous ailments, the Flitsians go every weekday to the center, where they get check-ups, physical therapy, two nutritious meals and a social connection that keeps them from drowning in the painful memories that have haunted them for much of their lives.

Boris Flitsian said they may forget their house keys, they may forget their birthdays, but they never forget every detail of the deprivation and deaths of loved ones during World War II, the post-war Stalinist purges that sent a pregnant Solomeya to a Siberian labor camp, or a subsequent hospitalization for depression.

“I have a lot of physical problems, I have a lot of psychological problems,” Solomeya said. “When I came here I felt safe. And I saw other people have problems and I’m not alone in the world. When I see they care about me, I feel that I’m a human being.”

The Flitsians and others ineligible for the new program will be contacted by Feb. 28 and referred to other community programs and resources, Ogle said.

The state nurses used criteria including whether participants could handle daily activities such personal hygiene, making meals and taking their medications. Conditions such as dementia and serious mental illness generally automatically qualified participants.

At Loving Care, co-founder Helen Kaminsky promised to appeal the Flitsians could have been disqualified and promised to help appeal the decision.

“We really believe we are helping them to stay alive,” she said. “If we let them go, they really have nothing else. So we will hold on for them.”

By July 1, participants in the new Community-Based Adult Services will be moved into Medi-Cal managed care programs that will reimburse the centers.

Meanwhile, center operators feel a sense of seige. They’ve been hit already with a 10 percent cut in Medi-Cal rates. Under the new program they’ve had to apply to become CBAS sites. And by July 1, all for-profit centers must become nonprofits to stay in the program. Right now, only about a third of the centers are nonprofits.

“We believe nonprofit centers represent a higher level of service delivery and accountability,” said Norman Williams, a state Department of Health Care Services spokesman.

A Medi-Cal Payment Error Study in 2009 found unnecessary medical services accounted for the largest category of possible fraud and more than 70 percent came from adult day health centers, according to the study.

But a switch to nonprofit status may be the tipping point for some centers.

At the Poway Adult Day Health Care Center, director Kathryn Holt said she had considered becoming a nonprofit when she opened 10 years ago. But “you can’t get a Small Business Administration loan,” she said.

SBA loans have allowed her to buy a building and renovate it, so she can provide programs for 104 participants.

“With the 10 percent Medi-Cal cut we’re getting the same reimbursement as 10 years ago,” she said. “And the nonprofit requirement is a huge issue for providers. It really feels like there’s an agenda to pull the rug out from under the whole adult day health care industry.”