Thursday, July 28, 2011


It’s sometimes difficult to remember that there actually was a time in our state’s and nation’s history when citizens and government collaborated to build bridges.  These were not just brides over waterways, but also symbolic links to a better quality of life. 

They included programs to offer bridges to a college education; bridges from poverty to employment; bridges to affordable and preventative healthcare; bridges to move people from nursing homes to independent living; and bridges to reward a lifetime of work with a secure retirement.

Today, these bridges to a better future are crumbling just like our transportation infrastructures.   Rivet by rivet, beam by beam, lawmakers are making budget cuts or eliminating these programs.

They are under constant attack and raising revenues is summarily rejected out of fear of the growing “no tax” mindset.  We forget that these programs were viewed as investments that reaped cross-societal and economic dividends.

Every engineer knows that there comes a point in time when a bridge's decaying structure cannot be saved.  A case in point is California’s Adult Day Health Care (ADHC) that provides center-based health and nursing care, therapies, transportation, and other services for low-income seniors and people with disabilities. 

California's 300 ADHC centers serve 37,000 people and give partial respite to family caregivers from their costly and time-consuming daily home care obligations for their relatives. However, advocates believe its foundation has been undermined by Governor Jerry Brown’s June 25th veto of AB 96.

AB 96 would have created an alternative to ADHC after it lost funding in this year’s budget.  It established the Keeping Adults Free from Institutions (KAFI) program as the new bridge program.

Supporters of AB 96 believed that a deal had been made to eliminate ADHC, but to replace it with KAFI at half the cost.  The Governor stated that he vetoed it because KAFI would duplicate the exact program model he had eliminated and that made no sense. 

The Governor did sign SB 91 allowing ADHC centers to operate without Medi-Cal licensing.  There are no guarantees, but state agencies reportedly are working to keep the basic model alive for those who can pay privately.  In theory, centers could be folded into HMOs or health plans as part of a continuum of care, assuming they survive.

Yet, ADHC providers, patients, and families feel betrayed.  Most centers face closure and up to 7,000 jobs are at-risk.  Experts predict that if recipients lose ADHC services that at least 4,000 prohibitively more expensive nursing home admissions and thousands of emergency room visits will result.

The Federal government approved extending ADHC's targeted elimination date from September 1 to December 1 to help keep recipients out of institutions.  Meanwhile, a Federal lawsuit has been filed alleging that  eliminating ADHC violates Federal law and would cause irreparable harm by placing recipients at-risk of institutionalization, hospitalization, injury, or death.  

The final outcome of this bridge closure is unclear.  Yet, once dismantled the ADHC infrastructures local communities created over decades probably cannot be restored in our fragile economy.

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