As an Elder Law Attorney, I often meet with families and caregivers to help them create a plan for the future care of a sick or elderly loved one. Since the desire is always to remain at home for as long as possible and to avoid or delay institutionalization, I often explore various services and benefits programs with my clients that will help them stay at home.  Adult Day Health Care Centers have always been an integral part of this planning.

Adult Day Health Care (ADHC) Centers are licensed day care programs that provide various health, enrichment and social services for the frail and elderly such as: individual assessments, counseling, therapy, much needed socialization, hot meals, day-to-day supervision, crafts and activities, support for caregivers and transportation to and from the center.  These programs are unique because they combine both medical and social services.

In California, some estimated 35,000 seniors depend on these services to avoid being placed in nursing homes. The ADHC Centers are a resource for those who need help, but who want to remain at home or living in the community. Without these programs, most participants in ADHC programs would not be able to meet their daily needs and would have to be taken out of their homes.

Not only are ADHC Centers beneficial to the participants of the programs, they are also a tremendous resource for the caregivers of those participants.  These Centers provide respite for those who provide full-time care for their spouses. Very often, I see caregiver spouses forego their own health and needs because they are consumed with the care of the sick spouse. Consequently, it is not uncommon for the caregiver spouse to become very ill themselves or even predecease the sick spouse. ADHC Centers are a safe place for someone to receive care and case management, giving the caregiver spouse an opportunity to rest, shop for household items, socialize or even go to their own, often-missed, doctor’s appointments.

Sometimes, adult children are also caregivers for their elderly parents and being able to send them to ADHC Centers during the day allows these caregivers to keep their daytime jobs.  Without these programs, many caregivers would have to quit their jobs and jeopardize their own standard of living.  Simply put, not only do these programs enhance the quality of life for the participants, but also for their caregivers. Without them, the only alternative for many frail seniors would be institutionalization and a complete loss of independence.

The ADHC Centers have operated as a successful model of care for some 40 years. Most of those who attend ADHC centers are covered by Medi-Cal, meaning they are not only medically needy, but also financially needy. Medi-Cal funding for ADHC programs is going to end as of December 1, 2011 and many frail elderly and their caregivers will have no place to go for the services and care they so desperately need.

One possible alternative may be to apply for benefits under the In-Home Supportive Services program (IHSS), which helps subsidize some of the costs of in-home care, based on an evaluation of need by a social worker.  However, it is not a good alternative due to the fact that it, too, has been severely cut recently.  Furthermore, IHSS participation and hours are determined by a social worker and ultimately, the care is provided in the home.  One of the biggest problems that the elderly and their caregivers face is isolation and lack of socialization.  ADHC Centers allow them to participate in numerous programs and socialize with others at the same time.

Although several advocacy organizations, including Disability Rights California, are attempting to bring a federal lawsuit as an effort to prevent the elimination of coverage for ADHC programs, there is no way to know for certain what the outcome will be.

From a long-term care planning perspective, it now becomes more important than ever for families to discuss their wishes and plans in the event of a serious illness.  Those who will be acting on behalf of an elderly or incapacitated person should know, among other things, what kind of care they wish to receive and where they would like to live.  I often see relationships between adult children of clients fall apart because they have differing views of what is in “Mom’s best interest,” and Mom never made her wishes clear.  Designating decision-makers for financial and medical affairs in the event of incapacity should be a priority and great thought should be given to these nominations.  While it is certain that planning ahead cannot avoid every potential problem, such as cuts to government programs and elimination of much-needed community services (such as those offered at ADHC Centers), it can definitely minimize the frustration, struggle and confusion that often arise when someone becomes ill or incapacitated.

Sara Polinsky focuses her law practice on counseling families and individuals in the areas of Estate Planning and Elder Law, focusing on eligibility for Medi-Cal Long-Term Care benefits.
She conducts several seminars and workshops for the general public throughout the Los Angeles area on topics such as “Living Trusts,” “Planning for Incapacity,” “Transferring Property for Long-Term Care,” and “Planning for Medi-Cal Long-Term Care Eligibility,” as well as in-services and trainings for case managers and social workers.  She is also the Co-Founder of Make A Senior Smile, a non-profit organization whose mission is to provide resources, life enrichment opportunities, and  generate smiles for seniors.  www.makeaseniorsmile.org.
Sara can be reached at sara@polinskylaw.net.

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