Calif. seniors fear budget cuts could endanger care

Anita Shapiro, who is 82 and lives alone, spoils the math.

Shapiro, who lives on Social Security of $1,134 a month, has more health issues than she can list. She has trouble dressing herself without the caregiver who visits her five days a week. She can't drive. She can't go to a store alone.

Without her caregiver, Shapiro would land in a nursing home, workers at the Ventura County Human Services Agency said.

Shapiro said she will never allow that to happen. She'll stay in her Moorpark, Calif. senior complex with or without caregivers.

"I just won't go to a nursing home. I'd rather die," she said.

Seniors advocates argue proposals for sweeping cuts to California's in-home supportive services and the elimination of adult day healthcare would cost more than it would save by driving people into nursing homes that cost Medi-Cal as much as five times more money.

If California legislators follow the governor's proposal to slash the support care programs or even come up with a compromise that still drastically reduces services, the financial benefit to the state will rest largely on the decisions of people like Shapiro and their family members.

If enough of them choose and then find nursing homes or end up in other residential care programs, the state's costs could over time rise and wipe out the more than $1 billion in short-term savings. But if they stay with their families or find other support, the state could trim its $20 billion deficit.

"We don't have a way to know what's in the future," said Lizelda Lopez, spokeswoman for the California Department of Social Services. "What we know today is that we're estimating these reductions will save a substantial amount of money."

It cost Medi-Cal, the state and federally funded insurance program, $185 a day in 2008 to care for a nursing home patient, according to state data. It costs the program $76.22 a day to provide care for one person through adult day healthcare services, used by about 1,500 seniors and developmentally disabled people in Ventura County.

Similar calculations are triggered by the governor's proposal to eliminate in-home supportive services for everyone except people assessed as having the highest need. If federal aid isn't dramatically increased, the governor proposes eliminating the program.

The state, federal and local governments together pay an average of about $858 a month to a caregiver for in-home supportive services in Ventura County. That compares to total Medi-Cal costs of more than $5,000 a month for a patient in nursing home care.

A California advocate for adult day healthcare centers said cutting that program would cost the state $88 million more than it would save in the next fiscal year because of the people who would end up in nursing homes or hospitals. But analysts say the equation depends on an unknown: how many people would end up in skilled nursing facilities.

The only way to know the answer is to watch what happens after the cuts, said Steve Wallace, associate director at the UCLA Center for Health Policy Research.

Though state administrators say they are motivated only by the size of the deficit, Wallace thinks the governor's proposal is driven by political gamesmanship.

Schwarzenegger is asking for more than he wants so the compromise is still far-reaching enough to have an effect on the state's budget, he said.

Providers of care services are immersed in their own calculations, hoping the damage can be staved off as it was last year when the governor proposed dramatic cuts but was blocked by federal courts.

About 160 people in the first 30 days would be in nursing homes or psychiatric hospitals, according to an estimate from Among Friends Adult Day Health Care Center in Oxnard. About 65 people at the Advanced Adult Day Health Care Center in Simi Valley would be in nursing homes, said an administrator there.

But many of the families say they don't know what they'll do if programs are taken away from them. Some of those who do know wish they didn't.

"I would have to put my mom in a home," said April Wiseman of Port Hueneme. She's a school food service worker. Her daughter goes to college. If her 79-year-old mother with Alzheimer's couldn't go to an adult day healthcare center five days a week, there would be no one to watch out for her.

"I'm trying to hold on to her as long as I can because that's my mom," Wiseman said.

Researchers in the state's nonpartisan Legislative Analyst's Office tried to calculate the breaking point, focusing on people who are not developmentally disabled but receive in-home supportive services. They said the proposed cuts would fail to bring savings to the state if about one-third of those people end up in nursing homes.

(Tom Kisken is a reporter for the Ventura County Star in California.)