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Proposed cuts would cripple state's adult-care system By Sara Myers, Special to The Times Thousands of Washington's most vulnerable seniors and disabled adults will be turned away from the health services they need to lead independent lives if parts of Gov. Gary Locke's budget become law. That budget cuts state funding for adult day-health care in half. It is a proposal full of personal tragedy and irony. Washington's aging population has the largest number of citizens over 80 in history. (This demographic group is growing at a rate faster than any other segment of our population.) Many of these individuals have serious chronic health conditions and have moved into nursing homes or other institutional settings. There is an alternative for many people however — community-based adult day-health care centers. Statewide, about 5,000 individuals with chronic illnesses such as Alzheimer's disease spend their day at these nonprofit centers where they get the health and human services they need, then return to their own homes in the evening to be with their families. Ironically (in light of the governor's proposed 50 percent funding cut) Washington state has until now been a national leader in this innovative, cost-effective system of community-based long-term care. Typically, clients at adult day-health centers suffer from Alzheimer's disease or other conditions and cannot be left alone at home during the day while their caregivers work. In many cases, a spouse (who is also elderly) becomes overwhelmed with the 24-hour responsibility of caregiving. It is likely that this same issue has faced someone in your own family. In situations such as these, adult day-health care becomes a life-saver for families who do not want to place their loved ones in an institution. About half of those who rely on adult day-health care in this state have very low incomes. This qualifies them for Medicaid-funded adult day-health programs, which pay about $46 per day. For this, the client gets meals, skilled health care, rehabilitative therapy and — perhaps most importantly — the chance to feel like they still are part of the community, not forgotten in an institution. Frankly, the state's reimbursement rate doesn't cover the cost of providing services, which is why most centers conduct charitable fundraising activities just to keep their doors open. Many of these doors will surely close if the $3.7 million cut in the governor's budget becomes law. When these centers close, they will close to all — Medicaid and private pay clients as well. Where will these vulnerable individuals go? A recent Oregon study may give some clue as to where they may be headed. About a year ago, the Veterans Administration closed its Portland adult day-health program. A registered nurse tracked what became of the displaced elders. A year later, 30 percent had died and 50 percent had moved to a higher level of care, such as assisted living centers and nursing homes. If Washington holds true to Oregon's experience, as many as half of our state's adult day-health clients (our parents and spouses) could end up in institutions next year. The governor proposes saving $3.7 million by cutting adult day-health care, but the state could end up spending over $20 million — more than six times as much — to care for the same people in institutions. The governor's proposal is penny wise and pound foolish. It will also disrupt the lives of thousands of vulnerable individuals and their families who care for them. Surely, the Legislature will have the common sense to correct this ill-conceived proposal. Sara Myers is executive director of the Washington Adult Day Services Association.
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