SONOMA, MARIN – A budget trailer bill meant to save the state about $2.5 million would force seven senior health care centers to close, including two in the North Bay, and drive most patients into more expensive residential facilities about double the cost.

“We are the only [adult day health care] centers serving our counties, and the loss of these programs would have a huge impact,” said Holly Rylance, program director for the Marin Adult Day Health Care Center.

“We are the medical home for the families that we serve. If we close, it will change from someone who can be fairly independent but needs some medication management and therapy to someone that is completely disabled and needs around-the-clock care.”

The Marin center and Southwest Community Health Center’s Adult Day Services in Santa Rosa are the only North Bay nursing, health care and restorative therapy-providing facilities for publicly supported seniors, and two of only 12 of their kind in the state. Under the tentative legislation, the state would cut the centers’ reimbursement in half, which would cause seven to close, according to an advocacy group survey.

“I think the biggest problem is the misconception about what services we provide,” said Southwest Adult Day Services Program Director Susan Beer. “Legislators looked at us and said, ‘How come we are paying them twice as much as other adult day centers?’ But really we are not the same at all.”

Currently, the state pays the centers about twice as much if they are administrated by a federally qualified health center. Of the 650 adult day centers in the state, a dozen have the health center license, which requires them to provide extended services warranting the higher reimbursement.

Unlike the vast majority of centers, the specialized facilities have at least one medical director and a registered nurse on site and provide occupational therapy, podiatry, speech and physical therapy, among other medical and social services. Other facilities also called adult day centers have a different license and in most cases only offer social programs like arts and crafts, music, games and other activities meant to provide participants social interaction and mental exercise.

Legislators are currently debating the budget amendment that would go into effect on July 1, if approved. The change would shrink payments per visit from about $161 in a prospective payment system to a flat, fee-for-service rate of $76.22. The actual cost to provide the care varies depending on the patient’s needs, but both centers said on average visits cost between $100 and $220. Both clinic leaders said they would close if the cuts are approved.

At the same time, Ms. Rylance and Ms. Beer estimated that between 30 percent and 40 percent of their clients would have to immediately be admitted into a residential skilled nursing facility, and almost all would within six months.

“Our goal here is to deter or delay the need for our participants to go into a residential facility,” Ms. Beer said. “But in the case where the time comes when that person does require that care, the wait for an open Medi-Cal–accepting bed can be months, and many times the person has to be placed out of the county.”

An analysis released by the California Primary Care Association late last month calculated that if passed, the cuts could actually cost more than the amount saved.

If all seven centers closed with the reduced payments and all the patients that needed to were forced into skilled nursing facilities, the federal and state governments would pay about $7.4 million more for their care annually.

The total annual reimbursement for residential facilities would be about $13.4 million. That’s based on the 2007-08 California reimbursement rate for skilled nursing facilities, or about $152.28 per day, multiplied by the number of patients in the seven federally qualified health center adult day care programs that would be moved to skilled nursing, or about 240, multiplied by 365 days in a year.

The annual cost to the government for the seven existing facilities is about $6 million. That’s figured from an average cost per visit of $160.58 multiplied by 240 patients, multiplied by the average number of visits a week, which is about three.


California Department of Aging: California Adult Day Health Care Centers