Send gramps to senior day camp

Benidicto Rico has been coming to the Ventura County Adult Day Health Care center in Oxnard for physical therapy, and in eight months he's regained more than the use of his hands. The 75yearold Camarillo resident has recovered his independence.

When he first arrived, he had very limited use of his bent, arthritic hands. He had to depend on others to do everyday tasks for him. Now Rico can put on his pants and hold the handles of a walker. That means Rico can leave his wheelchair and take care of his personal needs rather than relying on someone to help him.

Small acts that most people take for granted are huge victories for Rico.

"It's fantastic to come here," he said in Spanish. Cindy Tafolla, one of the center's social workers, interpreted for him.

As a result of the therapy, Rico's quality of life has improved and his independence has increased. Tafolla said if Rico hadn't shown such improvement, he probably would have been a patient in a nursing home by now. And not to be overlooked are the social benefits. Coming here twice a week gives him an opportunity to make new friends.

"It's hard to make friends when you're just at home," Tafolla said.

The health component

The state has more than 300 Adult Day Health Care centers; Ventura County has six. The centers' goal is restoration or maintenance of frail seniors' physical and mental abilities and independence.

Two government agencies regulate day centers. The California Department of Health Services licenses them, and the California Department of Aging oversees their programs and certifies them for MediCal reimbursement.

They are staffed with medical and mental health professionals including nurses, social workers, occupational, physical and speech therapists, a pharmacist, a psychologist or psychiatrist and a registered dietician. A physician generally visits once a week.

In addition to the range of medical, therapeutic, rehabilitative and social services, the centers offer classes and field trips, counseling, and physical, social and recreational activities. They also provide hot meals and roundtrip transportation.

Genny da Roza, program director for the fouryearold Oxnard facility, said day centers fill an important community need. There may come a time, she said, when the family of a senior in poor health can't handle all of the person's needs alone, but placement in a nursing home or other institution may not be appropriate.

To be welcome at a center an applicant cannot be violent and must function at a required level. The goal is to delay placement in a nursing home, psychiatric or assisted living facility.

"We're not babysitters," da Roza said. "We give them hope, a better quality of life, selfesteem."

Many younger clients have been diagnosed with psychological problems. Some are bipolar or developmentally delayed. But the majority of the Oxnard center's clients are elderly with a physical disability; some have dementia or Alzheimer's disease.

No longer so lucrative

Clients often are charged based on their income. But in many cases, Medi-Cal pays the bill. Legislators recognize the economy of paying for adult day care at $73 per day compared to supporting an indigent person in an assisted living facility or a nursing home, the daily cost of which can run between $83 and $200.

But Medi-Cal payments don't cover the entire cost of providing professional health services, da Roza said.

"For us it's never enough," she said. "You do the best you can; that's why you struggle. Everybody struggles."

Kiana Bahadoran, co-owner and program director of the Advanced Adult Day Health Care center in Simi Valley, said there was a time when such centers were lucrative operations for their owners. Not now.

"If someone is looking into it for a business, I wouldn't recommend it," she said.

"You really have to have love for people to take care of them, and you really have to have the patience," Bahadoran, an occupational therapist, said. "We're doing this not for a business; it's a public service."

Effects of moratorium

Nevertheless, an ADHC center is a business, and needs repeat customers to keep the doors open. Legitimate centers motivate clients to come in regularly by providing stimulating programs and enjoyable activities. But da Roza and Bahadoran have heard of centers that bribe clients with free merchandise-from toasters to washers and dryers-that can look especially attractive to someone on a low or fixed income.

Such schemes were among the reasons the state placed a temporary freeze on certifying new ADHC centers for MediCal reimbursement. The suspension, enacted in 2004, has been extended each year. The latest moratorium is set to expire in June of next year.

Patti Roberts, a spokesperson for the Department of Health Services, said some other reasons for the moratorium include state budget constraints and federal requests to reform the adult day care program.

Senate Bill 1755, signed into law last month, will be the vehicle for those reforms. It will tighten the criteria used to determine medical necessity for services and develop a rate structure to ensure services are provided, Roberts said.

"The moratorium will not be lifted until the reforms are implemented," Roberts explained by email.

The Medi-Cal freeze puts the American Veterans Adult Day Health Care Center in North Hills in the proverbial hard place. The San Fernando Valley center is licensed but is not MediCal certified.

Board Chair Lev Leznik said the application was submitted in 2003, a year before the moratorium went into effect, but due to bureaucratic misunderstandings, Leznik said, it wasn't approved in time.

Optimism, exhaustion

To help keep the center afloat, some staffers even donate their time. Activity director Veronica DuVal, whose husband is a veteran, said she hasn't accepted a paycheck in over a year; it's been more than four years since Leznik has been paid. The Agoura Hills resident said he's borrowed money on his house and credit cards to pay the center's bills.

"We're probably at the end of the rope," Leznik said, and the matter is likely to be settled in court.

DuVal remains optimistic. "I have faith in it. . .miracles happen here every day," said DuVal, a longtime supporter of war vets. "There's nobody around that does this for vets. We're it."

DuVal, a Thousand Oaks resident, picks up a Simi Valley man on her daily commute to work. He has no other means of transportation to the center.

The man is partially paralyzed from a stroke he suffered seven years ago and spends most of his time in a wheelchair. His wife, like many of those with a disabled family member, spends nearly every waking hour caring for him. She also works part time to supplement their income. The couple, both 69 years old, lives on Social Security.

Leznik allows the husband to come to the center every day without charge. But the wife is tired, and they are wrestling with what could be an inevitable conclusion-he may soon have to go into a nursing home.

"I don't look 70 years old, but I feel it," the woman said.