Assembly Hearing Raises Questions About Adult Day Care Transition

An Assembly hearing today will examine the state’s planned Oct. 1 transition from Adult Day Health Care to the Community Based Adult Services program.

A growing chorus of concerns has been raised about the new program for seniors and disabled so it’s important to examine plans closely before the transition begins, said Assembly member Mariko Yamada (D-Davis).

“Eliminating ADHC was a painful 2011 budget action taken with the understanding that strategic replacement services for some of our state’s most vulnerable adults would continue,” Yamada said.  “Despite a legal agreement establishing a standard for these replacement services, many of our constituents report continued problems in timely adjudication of appeals and access to care.”

The Department of Health Care Services, which is overseeing the transition, has said it is ready for the Oct. 1 launch and is eager to provide high-quality Medi-Cal managed care services to a fragile, high-needs population.

Concerns made a public appearance last week at a conference on long-term care issues in Sacramento. After DHCS medical director Neal Kohatsu presented the department’s approach to improving quality of care to high-needs beneficiaries, concerns were voiced during the question-and-answer period.

Nina Nolcox, CEO of an adult day care center in Los Angeles, said she appreciated the presentation, but was wary of the state’s follow-through on delivering better care.  

“This looks very nice on a slide show,” Nolcox said, “but as a provider, it looks very different.”

Nolcox said her center has received little guidance from the state, and that monitoring of this at-risk population has been spotty. “For instance, when AltaMed went out of business,” Nolcox said, referring to closure of an adult day center system in the Los Angeles area, “about a third of them went to PACE (Program of All-Inclusive Care for the Elderly), a third of them went to MSSP (Multipurpose Senior Services Program), but where’s the other third of these people?”

Deborah Doctor, a legislative advocate for Disability Rights California, had a similar comment: “There is a great contrast between what you said, what you hope will happen, and what’s actually happening,” she said.

Kohatsu said DHCS has benefitted from lessons learned in an earlier transition of seniors and persons with disabilities to Medi-Cal managed care plans.

“Quality improvement is cyclical,” he said. “In the department, we’re certainly looking at learning from that. Nothing runs perfectly in a huge system. We do want to learn from previous experience, and gather baseline data and follow that forward to make adjustments more rapidly.”

Gary Passmore, a member of the California Congress of Seniors board of directors, had a more pointed opinion.

“I think DHCS has screwed up the adult day health transition and we are on the verge of threatening the lives of thousands of elderly and the disabled in California,” Passmore said.

“This is the canary in the coal mine. When you look back, a lot of people were getting the care to keep them out of institutions, and 10 to 15% maybe didn’t need that care so intensively. But then, for that, we have to change everything?,” he asked. “This transition flies in the face of the state’s pledge to provide care in the community whenever possible, and this puts a lie to that pledge.

Passmore said he has always tried to work with state officials and give the benefit of the doubt to an agency that clearly is trying to improve the health of disadvantaged Californians. But he said he has had a hard time watching the adult day health transition.

“It is my fear that this is going to turn away a lot of people from turning to managed care, and it has made me question my support of it,” Passmore said. “We are engaged in a transition that is hurting people needlessly. The state is violating legal agreements, and it’s just plain wrong and it’s inexcusable.”

Kohatsu said he understood the concerns, but said DHCS has worked long and hard on the transition — and would continue to improve it.

“The devil’s in the details,” Kohatsu said. “We have to achieve a quality collaboration, and that’s what we’re doing.”

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