Cuts in day care for adult seniors are forcing more into nursing homes in California

At any given moment, seniors at Grace Adult Day Health Care Center in Sunnyvale, California may be exercising on stationary bikes, gabbing over lunch, playing word games or bending over an intense chess match.

This day care center for the old and infirm is the kind of place that health care experts say is critical to keeping the elderly in their communities and out of costly nursing homes.

Yet with state lawmakers slashing funding for adult day care centers’ programs by more than half, co-owners Manooch and Suzanne Pouransari are now facing the prospect of closing their doors.
And the ultimate irony? The Pouransaris are considering opening a nursing home.

The dilemma for adult day care centers exemplifies a collision taking place across California between federal health initiatives and state budget cuts. Even as the federal government devotes increasing sums to keeping people out of institutions, state spending reductions are gutting many programs that provide the best alternatives.

In Santa Clara and other California counties, the federal government is spending $10 billion over five years to expand public health programs to uninsured residents in advance of 2014, when the major provisions of the national health care overhaul kick in. This “Bridge to Reform” directs participating counties to better manage chronic diseases before patients land in emergency care.

But those efforts are undermined by cuts to the very community-based programs that do just that.

“The bizarre disconnect is that we know that home-based care is the answer,” said Cheryl Phillips, outgoing chief medical officer of On Lok, a longtime provider of community-based long-term care in the Bay Area. “But in our (budget) crisis, we can’t seem to have the short-term dollars to pay for the long-term solution.” The Pouransaris’ preference is to keep their center open, but they may have no choice.

“Even if we put just 50 people in a nursing home,” Suzanne Pouransari said, “it will cost the state more than keeping the whole (adult day health care) center open.”

On a typical day, about 135 people attend Grace. All are on Medi-Cal, the state’s Medicaid health insurance program for low-income residents, meaning the center is entirely dependent on government funding.

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