natalie hoffman, st. helena star: ca state cuts decimate healthcare safety nets for poor & vulnerable (017)

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State cuts drain money from local programs

By Natalie Hoffman
Saturday, September 05, 2009

Saturday updateJuly brought the California Legislature’s passage of a state budget largely shoring up California’s $26 billion shortfall, but local elder advocates are lamenting massive cuts to safety net programs for low-income seniors and the disabled.

Among Gov. Arnold Schwarzenegger’s line-item vetoes are virtually all state funding for the Linkages Case Management program, Alzheimer’s Day Care Resource Centers and Senior Brown Bag program — all of which health experts say help vulnerable adults stay more independent and avoid premature placement in nursing homes and other institutions.

Cuts to the three programs translate locally to a total loss of more than $380,000 annually, according to Leanne Martinsen, executive director of the Area Agency on Aging serving Napa and Solano.

A direct service of the Agency on Aging, Linkages serves functionally impaired adults who would qualify for placement in facilities without the program’s help. In 2008, Martinsen said, the program reached 119 clients in Napa and Solano counties, providing them with case management, connecting them with housing, in-home help and linking them with other basic services.

Martinsen said the cuts put the Linkages population especially at risk, because most of the clients are not senior citizens and therefore don’t qualify for government benefits reserved for the elderly. What’s more, clients who rely on state-funded programs may also use in-home support from county-run programs, which are also facing cuts.

“The whole system is being eroded,” Martinsen said. “I think it’s important to understand that a lot of these people don’t have many other options.”

Also on the chopping block is funding for the Alzheimer’s Day Care Resource program — a respite day program serving about 65 local seniors with dementia and run locally at Adult Day Services of Napa Valley. The new state budget also calls for capping the Medi-Cal benefit for the program to a maximum of three days a week when most seniors need the service Monday through Friday, according to Celine Regalia, program director at Adult Day Services of Napa Valley.

“These are people who will have a hard time paying out of pocket for the services (because) they’re low income. … “At the same time that cuts are happening here, they’ll be losing their in-home supportive services and they’ll have less care in the home,” she said, adding that private in-home care can cost between $20 to $25 hourly.

Some are coping with the budget cuts by pooling family resources to pay out of pocket for services at Adult Day, and the agency is using a sliding fee scale. In other cases, family members are revising their work schedules to make themselves more available as daytime caregivers.

Shirley King, director of the Napa Valley Food Bank program, said state funding for the Senior Brown Bag program — which furnishes low-income seniors twice monthly with a bag of grocery staples — is being completely eliminated and the organization is soliciting donations.

More than 400 seniors used the program in 2008, and King said the number is likely to grow until the economy improves.

Children’s services hit

In addition to the elderly, the underinsured and uninsured are also taking a big hit with the new state budget’s passage, especially children covered by Healthy Families, which provides children’s health, dental and vision coverage.

“Cuts to Healthy Families are probably the most devastating in terms of health care to the uninsured,” said Beatrice Bostick, executive director of Clinic Ole. “They’ve stopped enrolling new children into (the program) … and starting Oct. 1, as children hit their annual re-application date, they will be exited from Healthy Families (coverage).”

The majority of these children will become uninsured, she said.

“This is a huge cut to community clinics as far as income goes because the children will absolutely be able to come here for services,” she said. “We were thinking (our) new building would be for pediatrics because we knew something was coming, but didn’t expect the extent of these cuts.”

Because the Healthy Families program provides both medical and dental coverage, the clinic will be losing income on both fronts when children lose coverage. Visits by children covered by the Healthy Families program represented about one-third of dental visits to the clinic last year, she said. About 3,930 local children are currently enrolled in the program and Clinic Ole will lose between $150,000 and $200,000 annually in income when it loses reimbursements for Healthy Families patients.

The clinic is already grappling with losing about $300,000 per year in reduced reimbursements from Medi-Cal for adult dental benefits, but Bostick and other clinic officials “will do our absolute best to maintain our amount of services to the community.”

Elder watchdog cuts

Also feeling the pain is Napa’s Long-Term Care Ombudsman Program, a watchdog organization that handles complaints from residents at local nursing homes and makes regular surprise visits to the facilities.

Elizabeth Mautner, program coordinator for Napa’s Ombudsman chapter, said cuts to the program put seniors especially at risk because slashing safety net programs is likely to land more elderly people in nursing homes.

Emergency funding provided by AB 392 will replace just $9,000 of the $48,000 in state funding cuts to the program, she said. Although other emergency state legislation is pending, it’s likely to be fought by the nursing home lobby, she said.

“Cutting the Ombudsman Program … reduces our ability to go into our facilities and we can’t keep an eye on what we should be keeping an eye on” in-between licensing agencies’ visits, she said. About 2,000 of Napa County’s residents live in facilities overseen by the Ombudsman Program.

Mautner said her staff now includes four part-time employees, one of whom is reducing their hours by half. All employees are cutting back their working hours voluntarily and the organization’s officials opted not to replace an administrative secretary.

“So far, we’re doing OK,” she said. “We have not necessarily curtailed our activities as much as many of the (other Ombudsman) programs have.”

When it comes to county-administered safety net programs, much is still unclear as to how the state budget will impact Napa County. But Health and Human Services — which suffered a June round of severe cuts to its mental health, drug and alcohol counseling for the elderly and family planning programs — will take a considerable hit.

Napa County will probably have a new budget in September and in addition to California Healthy Families, the county’s mental health program, CalWorks, In-Home Support Services, probation and HIV/AIDS education programs will face considerable cuts, according to county officials.

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