Is Medi-Cal Coverage for Adult Day Health Care in our Future?

January 8, 2014 – The court settlement that preserved Medi-Cal coverage for Adult Day Health Care will expire on August 31, 2014. That settlement gave the benefit its new name – CBAS, for Community-Based Adult Services – and transitioned the benefit from Medi-Cal fee-for-service to a Medi-Cal Managed Care Plan benefit in Alameda and many other counties. The settlement thus gave CBAS the distinction of being the first LTSS to move into Medi-Cal Managed Care. It also bought time, enough to allow California’s Department of Health Care Services to change its opinion about eliminating the program.

In October 2013, DHCS acknowledged that “CBAS is a key component of LTSS under the Coordinated Care Initiative” and “an important Home and Community-Based Service that provides alternatives to institutional care.” More, DHCS and the California Department on Aging launched a CBAS Stakeholder Workgroup. Its purpose is to develop a future (post-settlement) direction for CBAS, and to prepare for amending the CBAS section of the federal 1115 Waiver (itself set to expire in August 2014).

This bodes well, as does the meaningful participation of an impressive and broad set of workgroup members. The Workgroup will meet three times (Jan. 9, Feb. 4 and March 6) before they must complete their deliverables in April. The door is open for the public and service providers to participate at the meetings (in person and by webinar), and to offer comments and recommendations in writing (by emailing CBAScda@aging.ca.gov) or by phone (916-419-7545) through April 2014.

To sign up to receive email notices, and to view meeting materials, go to http://www.aging.ca.gov/programsproviders/ADHC-CBAS/Stakeholder_Process/

 

Return to the CCI Policy Developments page.

Hello, is Anyone Listening? California Assembly’s Budget Blueprint Leaves Out Seniors!

January 8, 2014 – Have you ever felt ignored? In a proactive move, ahead of the Governor’s budget proposal scheduled for release this week, California’s Assembly Democrats recently released their 2014/15 Blueprint for a Responsible Budget (click here to check it out). The plan responds to the Legislative Analyst’s Office recommendations for keeping us on the path of fiscal stability now that we have a structurally balanced budget. It would build reserves and increase investments, and be smart about it. Unfortunately, the Blueprint makes no mention of seniors.

Over the past ten years, California has dismantled its safety net for seniors. While the population of seniors grew exponentially, state funding dropped by half (click here for the charts). State funding vanished for many programs, including cornerstones of the Older Californian’s Act. We are talking about services designed to help seniors successfully navigate the challenges of aging so that they can maintain a steady state. Food, caregiver respite, day care, foster grandparents, senior companion, case management, senior employment…the list of cuts and eliminations is stunningly long (click here to see it). Some programs are just barely holding on – at least in some counties – with local and federal funding. But nowhere is there capacity to serve the need.

Why is there no mention of restoring these services in any of the grand plans for California’s turn-around? It can’t be because they are too costly. Returning the Older Californian’s Act budget to its 2006 levels would only take $30 million, a small sum when we are looking at putting aside a $2 billion surplus for fiscal 2014/15. It can’t be because seniors don’t contribute to the Blueprint priorities of expanding opportunities for California’s families, investing in education, reducing poverty and investing in jobs…See foster grandparents, caregiver respite, day care and senior employment in the previous paragraph.

Certainly we’re in for a lively debate about how California can craft a final budget that reflects our priorities. Let’s just not forget that “our” priorities include those of seniors. I hope you will join me in attending state budget hearings and contacting your legislators to remind them.

Stay tuned.

Return to the State Budget page.

Senior Support Program of the Tri-Valley

Building a Village, One Outcome-Based Program at a Time

January 3, 2014 – Marlene Petersen, Executive Director, describes the approach that SSPTV uses to serve over 3,000 seniors a year as “taking care of the whole person.” The organization serves the Tri-Valley area – encompassing the cities of Pleasanton, Livermore and Dublin. It’s a unique community that is fairly isolated from the rest of Alameda County services, and because of that, SSPTV has formed an eclectic set of services in response to local needs.

One-Stop Shop

SSPTV has a fortunate location, on the site of the Pleasanton Senior Center. This allows visibility and, so seniors can find SSPTV, and helps Petersen’s staff coordinate with a host of other senior programs (among them health insurance counseling, meals, educational programs, etc.). Petersen’s staff connects seniors, assisting with applications and navigating any enrollment process. People in crisis often need more than a referral; they need an assessment to determine the right referral, an introduction, and an understanding of what help to ask for. Says Petersen, “We built ourselves on watching and listening to what seniors are really going through and making sure we don’t add to their problems.”

To connect homebound or isolated seniors with support and community, SSPTV had to develop creative programming and collaborations. “The seniors who come to the senior center and are active in the community, they’ll find us. But there are those who are never going to ask for help but when crisis comes along, they call 911.” Starting in 1981 with a Friendly Visitors program, SSPTV set out to build connections.

A Host of Programs

SSPTV’s Friendly Visitors program started with 35 clients; today the program has 250. Friendly Visitors matches the needs and interests of each senior with those of a volunteer. The program has succeeded in opening doors and lives to fulfilling experiences, and reestablished healthy social connections. Petersen notes the biggest challenge is that “once they become friends, they don’t even remember us.”

SSPTV’s In-Home Counseling Program provides one-on-one counseling and emotional support for seniors in their homes. Counseling in the seniors’ own homes is more likely to be successful because of this inherent comfort level. Says Petersen, many seniors “have lived a lifetime in hiding, from abuse, alcoholic parents, etc., so there’s a lifestyle that now reflects that. It doesn’t come out easily.”

To maintain the individual needs of independent seniors and their support structures, SSPTV provides Case Management and Family Caregiver Support services. Case Managers visit seniors at home for a comprehensive assessment, and create care plans to support seniors’ goals of living independently. Says Petersen, “Everything we do comes from the senior. We’re building trust first and foremost.” To complement this system, SSPTV’s Family Caregiver program helps caregivers with a number of resources, from planning to support groups. “We serve the whole person: body, mind and soul,” says Petersen. Additionally, SSPTV employs monthly monitoring to ensure the senior is following and succeeding with their plan’s outline.

SSPTV’s Finding Wellness is a program intent on developing each participant’s complete understanding of the benefits of nutrition, exercise, and alcohol/drug management. The program combines case management, education and a support group. Classes resemble circles of sharing. “We don’t instruct, instead we converse with seniors” says Petersen. “We get our points across” on the impact of alcohol on older bodies and brains, medication issues, falls, etc.

SSPTV’s philosophy emphasizes friendship and trust. Petersen says this allows them to “help more people because no one is afraid of us. Most people who go through the program, they’re connected and have people that care about them. That’s the biggest success.”

A Community of Partnerships

SSPTV maintains an active partnership with the local Rotary club, annually organizing over 100 volunteers to clean and repair about 100 homes. “The volunteers do gardening, they turn mattresses, sometimes they paint a house – whatever the senior needs.” SSPTV also calls on the Rotary during the year to help seniors with special needs, and has developed similar relationships with local numerous churches. Says Petersen, “It’s so amazing what the community does to make this work. It’s not Senior Support Program standing alone.”

Partnering with local Police and Fire represented a significant milestone in SSPTV’s development. Petersen described the challenge: “Emergency responders would arrive, take the senior to the hospital, but then they’re released from the hospital and sent home with no support. We wanted to make a connection when they went to the hospital, so we could visit them there and let them know services were available.”

Now in its second decade, SSPTV’s partnership with the local Fire Department includes training for first responders. They are trained to recognize dementia and other issues, assess the status of the spouse who is left at home when the caregiver is admitted to the hospital, and to make connections and warm referrals to SSPTV. “Our phone number is in their engine,” says Petersen, and “when the Fire Department says to seniors, ‘You need to work with SSPTV,’ they listen.”

Partnership with Hospitals and Managed Care?

SSPTV is working towards developing partnerships with hospitals. Though they don’t currently bill Medi-Cal or Medicare, “We know we’re the best continuum of care that any of these facilities could ever have,” says Petersen. “When seniors leave that hospital and we’re there, they aren’t readmitted because we’re providing services that prevent them from being back in the hospital.”

Return to the Changing Landscape of Aging Services page.