Opinion: MediCal cuts would send more into deadly nursing homes

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By Dr. Kate Scannell, Mercury News, June 3 2020

The East Bay Post-Acute Healthcare Center in Castro Valley. where 16 patients have died of the coronavirus as of May 25. (Jane Tyska/Bay Area News Group)

I can’t imagine a worse time than the present to feel forced into living in a nursing home. Not while half of all COVID-19 fatalities in California are occurring in eldercare facilities.

Not while we are repeatedly traumatized by deeply disturbing stories about the aloneness of nursing home residents in COVID quarantine, even while dying, separated from their loved ones. Not while the cost for such institutionalized care is many-fold higher than the cost for remaining at home.

But if Gov. Gavin Newsom’s proposed revisions to the 2020-21 state budget are passed by lawmakers, tens of thousands of elderly and disabled Californians will lose the in-home support from MediCal that has been helping them to live independently. And losing that will force many of them into long-term institutions, like nursing homes or assisted living facilities.

That’s because the governor’s proposed budget cuts would force the closure of all adult day health programs in California that depend on funding from MediCal. MediCal is our state’s version of the federal Medicaid health insurance program provided to low-income seniors and disabled adults who, to qualify, must make less than $17,600 a year.

These adult day health programs provide the proverbial helping hand to a small subset of MediCal recipients: about 46,000 frail Californians with medical, cognitive or behavioral conditions who need help to function at home.

That help includes professional nursing and social services, mental health care, physical and occupational therapy, healthcare coordination and transportation assistance. And it can provide daycare at a health center where recipients can socialize with others, engage in physical and mental activities, and obtain a decent meal.

These programs not only support those among our state’s poorest and most frail adults. They provide critical assistance to the caregivers — mostly women, mostly unpaid or poorly compensated — working to uphold the dignity and independence of loved ones who wish, often desperately, to avoid nursing home placement.

For family and friend caregivers, even an occasional freed-up hour to meet personal needs can make all the difference in the world. And when regular adult daycare is provided, the caregiver is also freed to pursue a paying job — as daunting a task as it has become to find one now.

State taxpayers are also helped when these MediCal-funded community programs prevent costly emergency room visits and hospitalizations for at-home vulnerable recipients. And the benefit can prove substantial when nursing home institutionalization is circumvented; the cost varies significantly, but a typical MediCal reimbursement hovers around $41,000 annually.

The COVID-19 pandemic has ravaged the country, and the California economy as well. Our state began the year with a surplus, but now faces a whopping $54.3 billion deficit as a result of lost revenues. The governor projects a peak unemployment rate nearing 25% in July, and the addition of 2 million more people to the MediCal program. All this is to say, that the state’s economy is hemorrhaging and more budget cuts and adjustments will have to be made.

But let’s be clear about this particular cut, during this particular time. It takes primary aim at extremely vulnerable seniors and people with disabilities. And it sends them this chilling message: While we claim to be horrified by high COVID-19 fatality rates in California’s long-term care facilities, we’re withdrawing the hand we’ve been extending to protect you from, literally, ending up in one.

Kate Scannell is a Bay Area physician and author of the novel “Flood Stage.”