Adult Day Health Care system imperfect but needed

Expert offers critique, advice to those impacted

As legislators in Sacramento struggle to balance California’s budget, tough decisions are being made regarding which services to either fund, curtail or eliminate all together.  As a result of these difficult budgetary decisions, one program which is teetering on elimination is support for Adult Day Health Care (ADHC).

ADHC facilities provide a safe place for the disabled and elderly during the daytime when their loved ones are not available to care for them due to work or other reasons.  These facilities essentially assume the role that family members traditionally played when they stayed at home to watch a loved one who was not fully capable of self-care.

On July 25, 2011, Governor Jerry Brown vetoed Assembly Bill 96, Keeping Adults Free of Institutions (KAFI), which would extend funding for ADHC facilities.  As a result of Brown’s veto, the California Association for Adult Day Services (CAADS) projects that 95% of these facilities will close by December 1, 2011. If this prediction comes true, as many as 38,000 elderly and disabled people will be impacted.

To get a better understanding of these facilities and the impact on the community, CaribPress spoke recently with Roy Davidson, a home health care administrator and educator with over twenty-five years of experience. Currently, he is CEO/President of UNI Healthcare, Inc. in Valencia, California, just north of Los Angeles. UNI Healthcare provides consultation in Home Health, Hospice, Private Duty Nursing, Adult Residential and Residential Care Facilities. He also operates UHEN, a Private Home Health Agency.  As someone who also utilized ADHC services on behalf of his late father, Mr. Davidson offers a unique perspective on this important issue.

Mr. Davidson is convinced that ADHC facilities provide a valuable service to those who truly need it. “People who really need the service,” he says, “are going to suffer” as a result of the closure of these facilities.

However, from an administrative standpoint, Mr. Davidson believes that the current program should be scaled back because the system was poorly regulated and inefficient. “In the past five years, too many [ADHC facilities] were set up,” he says, “causing a strain on the [state’s] budget.”

In particular, Mr. Davidson believes that the state should have stricter criteria for establishing an ADHC. ADHC facilities were allowed to be established in locations without regard to the needs of the community, he says. As a result, some communities had an overabundance of facilities, while other areas were underserved.

Another issue for Mr. Davidson is the degree of access to these facilities by those who utilized the services.  Because of lax administration, it was relatively easy for families to obtain service in some areas. He says that some “people were taking advantage of it” as a convenience rather than a need. They had other options.

Mr. Davidson, a native of Jamaica, doesn’t believe that the ADHC closures will have a significant impact on the Caribbean community. He says, “We are used to taking care of our loved ones.”

For those who will be impacted by the imminent facility closures, Davidson offers several suggestions:

1. Look for support from the extended family. Perhaps there is a family member available to care for a loved one impacted by the closures.

2. See if your boss will allow you to work from home, so that you can provide care for your family member at the same time.

3. Utilize the services of private caregivers. This can be either through a referral from a private agency or through direct employment of the caregiver by the family.

Ideally, the best option according to Davidson is to work with a private agency.  However, he emphasizes the importance of comparison shopping and careful negotiation to obtain the best terms.

Hiring a caregiver directly can also be a viable option, but under this scenario families must assume greater responsibilities.  They must in effect serve as employers, who are required to provide worker’s compensation insurance and payroll tax withholding. They must also carefully screen potential employees and assume the cost of background checks.

In anticipation of these costs, Davidson recommends careful saving and the purchase of long-term care insurance.  However, he acknowledges that these options may be out of reach for some families.

“The poor and the needy get hurt the most,” Davidson says.

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