Each week, life-long El Sereno resident Alejandro Alvarez and his 73-year-old mother, Maria Alvarez, look forward to the arrival of a handicapped-equipped shuttle van that will free them for a short while from the confines of their mundane lives. Separate vans drop each of them several days a week at a state-funded Adult Day Health Care center, where they participate in activities with friends, exercise and receive much needed therapies.
Read this story IN SPANISH: Recortes Obligan la Transición de los Centros de Cuidado de Adultos de AltaMed 
But funding to such ADHC centers is scheduled to end on Dec. 1, so 48-year-old Alejandro — partially paralyzed after suffering his fifth stroke just three months ago — anticipates he’ll be forced to spend a lot of time sitting in front of the TV “feeling lazy and bored.”
His younger sister Frances Burgoin worries that without somewhere to go, her brother’s health will decline and he’ll turn to alcohol to deal with the isolation.
Strokes run in the Alvarez family, she says. Alejandro’s mother has had several, leaving her paralyzed and unable to speak. Burgoin first turned to In-Home Supportive Services workers to help care for her mother, but after receiving as many as six calls a day from workers complaining about her, Burgoin said she had to make a decision.
At the time, she thought about placing her in a nursing home, but “I can’t do that,” she told EGP.
Burgoin quit her job and took over her mother’s, and later her brother’s care. Then she found out about AltaMed’s adult daycare program, and it proved to be a great alternative to a nursing home for her mother and her brother.
Her mother attends AltaMed’s Senior BuenaCare Center in East Los Angeles, a PACE — Program of All-Inclusive Care for the Elderly — site that will not be affected by the budget cuts.
Alejandro receives ongoing physical therapy at AltaMed’s center in Lincoln Heights, but because of his age, Alejandro will not be as lucky as his mother. He cannot afford to pay for the ongoing physical therapy he receives, and Burgoin is having a difficult time finding a therapist who accepts Medi-Cal.
With a little over a month before funding runs out, a number of ADHC programs across the state have already shut down, but AltaMed, the largest ADHC provider in the state, says it will continue to provide services until Nov. 30, the last day of funding.
Several postponements to the cuts have left AltaMed’s adult daycare patients, their families and staff at the centers uncertain about their futures. But while they continue to hope the program will somehow be saved, most are preparing for the worst.
“What I often hear is, ‘Well, what do I do with my mother? I have a job …’” said Claudia Estrada, El Monte AltaMed ADHC program director.
She said several people have told her they feel obligated to quit their jobs and perhaps file for state benefits in order to care for their loved one. Some of the disabled patients, who no longer qualify for services, may have to fend for themselves, increasing their risk of institutionalization and costly visits to the emergency room, Estrada said.
Helping patients avoid institutionalization is the main purpose of the adult day care program, she explained.
AltaMed’s ADHC participants receive physical, occupational and speech therapy. Staff monitor the patient’s health and alert their doctors or families when their health is declining. The centers provide social and therapeutic activities, nutritious snacks and lunch, health education, and transportation to and from the center.
Whether Alejandro Alvarez’s condition will deteriorate to the point of requiring him to enter a skilled nursing care facility is unclear. What is clear, says his sister, is that closing the site is sure to set his recovery back.
“If he just sits at home for five years, he’s basically risking damaging a lot of the muscles and nerves he could be recovering if he got [physical therapy] services immediately,” said Burgoin, frustrated that state officials have decided to cut the program.
Adult Day Health Care is an optional Medi-Cal benefit that the state decided to eliminate in order to help cut California’s budget deficit. Earlier this year, state health officials sent letters to patients stating they would “sunset” the program, according to Jennifer Spalding, AltaMed vice president of Senior Care Operations.
AltaMed and other adult day care providers lobbied hard to stop the cuts, to no avail.
“We know that the money cut from the programs will in the long run cost the state more, as disabled patients’ conditions worsen and the state is forced to pay for more expensive care in skilled nursing facilities,” AltaMed Chief Executive Officer Castulo de la Rocha told EGP earlier this year.
State cuts to ADHC were made at the beginning of the year, but the program has been extended month after month, Spalding told EGP. “We’ve been advising patients that this may be something that is coming on and that we want to be here to support them and to help them,” she added.
AltaMed estimates 350 to 400 of their 1,200 ADHC patients will qualify for the more intensive PACE health care program, according to AltaMed spokesperson Lauren Astor.
To qualify, participants must be 55 years or older, live within the service area and meet the tougher medical criteria for admission to a skilled nursing facility, but still be able to demonstrate they can live safely at home with the support of the program.
The two programs are funded differently. The ADHCs are compensated on a fee-for-services reimbursement formula by the state, while PACE programs are paid by the state and federal government under an actuarially based formula.
Lincoln Heights ADHC Supervisor Brigette Lizarraras said PACE programs are like ADCH sites “on steroids,” because the level of health care provided is significantly higher in the clinical setting where seniors are much lower functioning. She said PACE sites tend to be much larger, accommodating up to 200 patients a day. In contrast, ADHC sites like the one in Lincoln Heights that Alvarez attends, see about 35 to 95 patients a day. Overall, the total number of patients served will be fewer while per patient cost will be higher.
Those who do qualify will now attend sites such as the East Los Angeles Senior BuenaCare program where Maria Alvarez goes. AltaMed has applied to covert three of their four adult daycare sites — Lynwood, Downey and El Monte — to PACE centers, increasing the number of PACE centers it operates to six. All three sites have already gone through a federal Department of Health Care Services Readiness Review, and a final decision is pending from the Centers for Medicare and Medicaid Services, according to Astor.
The Lincoln Heights ADHC site will close and patients eligible for PACE will go to the nearest center in Chinatown. The centers in East LA (Whittier Blvd) and Pico Rivera will also close.
It is unclear how many of the adult day care staff will still have a job when the program ends, but AltaMed has said they are hoping to transfer as many workers as possible to other AltaMed programs.
Facing Hard Choices
Garvanza residents Juana Roselia and Florentine Valdez adore each other. She’s her husband’s primary caretaker, making sure he eats, helping him dress and making sure his diabetes is not affecting his feet. He looks around for her when she’s not by his side, growing anxious until she returns.
Juana, 85, and Florentine, 87, have known each other since childhood and for the last 62 years they have been inseparable. The ADHC program has allowed them to spend every day together, as they struggle to hold on to the lifetime of memories fading away as Florentine’s Alzheimer’s disease advances. The state cuts, however, could separate them.
Florentine qualifies to transfer to a PACE site, but Juana, who struggles with depression and anxiety and has high blood pressure and osteoporosis, does not. She’s become more attached to Florentine, and told EGP she no longer takes his gestures of endearment lightly.
Both currently go to the ADHC center in Lincoln Heights. The center offers Juana the opportunity to keep her medical condition under control and a chance to socialize with other seniors, while still having her husband cared for and close by. Their daughter Ara Vidales worries that her father won’t go to a PACE site without her mother. Juana is afraid to let her husband go without her, since she knows his Alzheimer’s can leave him disoriented and confused.
Juana says Florentine has gone missing more than once, and recalled how frantic she was the day he disappeared from a shopping center he knows well. The police found him very far away, 8 hours later, around midnight, she said. He just left the mall and kept walking…
“He has given us several scares, but luckily we’ve been able to find him again.”
In 2009, 68-year-old Jose Niño suffered a stroke while at work. Like Alvarez, he too is partially paralyzed. “I’m happy and content with the services they are giving me here, but at the same time I feel sad and worried because I don’t know what is going to happen to me if they close this center,” the Highland Park resident told EGP.
While Niño qualifies for the PACE program, he’s torn about going because he would have to replace the doctor who has cared for him since his stroke with an unknown, in-house PACE site doctor, or stay home and forego the therapy and other services that PACE offers. It’s a hard decision to make, he said.
Meanwhile, AltaMed is trying to connect the clients they will no longer serve at the adult daycare facilities to other AltaMed resources, including the Multipurpose Senior Services Program (MSSP), In-Home Supportive Services (IHSS), Managed Care Plans and community resources such as Meals on Wheels.
While those programs can provide some valuable assistance, Lincoln Heights ADHC supervisor Lizarraras says that AltaMed’s staff worry they are not enough to meet the ongoing medical and social needs of the patients they have come to know and care about.
“The majority of people will tell you what they did before they came here,” she said, “which was sit in front of the TV and do nothing but stress about things… and once we close, it’s kind of like being back at square one for them.”