If Gov. Gregoire’s proposed budget is enacted the adult day health program, a vital part of the safety net that protects our most vulnerable citizens, will vanish. The consequences for Washington State’s elderly and disabled citizens will be terrible.
Thousands of seriously ill seniors and disabled people will have their lives upended and their fragile health put at risk. Yet even as their quality of life decreases, the state will end up paying more, because many will be forced into nursing homes or other expensive care facilities — at a far higher cost to the taxpayer.
Adult day health is an innovative, community-based approach that provides people with conditions such as Alzheimer’s, severe autism or serious brain injuries a safe and welcoming environment. ADH providers ensure this vulnerable population receives quality health care, rehabilitation therapies, mental health treatment, and support services, as well as life-enriching opportunities for social interaction. And ADH serves as an efficient chronic care management program, helping to hold down health care costs of participants.
ADH also provides critical respite for family caregivers — two-thirds of all long-term care is provided by families — giving those caring for a loved one the breathing space to go out and shop, work or run errands. Without it, caregivers will burn out, and their elderly relatives will be pushed into nursing homes sooner as a result.
In Snohomish County alone, ElderHealth Northwest serves more than 300 frail elders with chronic or terminal illnesses at its adult day health centers in Everett and Marysville. Its specialized programs for adults with developmental disabilities or acquired brain injury are the only day treatment programs in the county. ElderHealth will likely shut down entirely if Medicaid funding evaporates, which would harm seniors in Snohomish, Mill Creek and Edmonds as well.
At present, 1,900 low-income seniors and disabled people statewide benefit directly from adult day health at a cost to the state of about $10 million per year. Without that funding, another 2,000 private pay clients will lose access to ADH services as providers like ElderHealth close their doors.
Aside from the ethical dimension, eliminating adult day health does not make fiscal sense. A year of ADH costs about $7,000 per year, or about one-ninth the cost of treating someone in a nursing home (which runs more than $60,000 annually). Thus, if only 10 percent of these seniors move into nursing homes because of these cuts, the state will be on the hook for $12.5 million — more than the cost of the entire ADH program.
Recent history makes it clear that far more than 10 percent of these people will end up in high cost facilities. In 2000, the Veterans Administration Hospital in Portland closed its ADH program. Over the next year, half of its former participants moved into nursing homes; another 20 percent died. Those sobering numbers demonstrate the short-sightedness of the current proposal.
And it isn’t even necessary. The federal stimulus package now before Congress will likely provide several hundred million dollars more in Medicaid money to the state than had previously been expected. That money is intended to shore up the Medicaid system for low income seniors by preserving essential programs such as adult day health. As a matter of basic fairness, the state must resist the temptation to divert this new money to other uses, as some in Olympia have suggested.
Some legislators recognize the important role that adult day health plays in improving the lives of our elderly. As the session began, ADH funding was under threat of being eliminated in the supplemental budget, which would have meant ADH shutdowns beginning on May 1. House Ways and Means Chair Kelli Linville deserves applause for restoring short-term funding for ADH, at least through June.
But that is only a stay of execution. Unless adult day health is put back in the upcoming biennial budget, providers across the state are going to begin shutting their doors within months, and the effects will ripple out through our social service system. Family members caring for loved ones with Alzheimer’s or other illnesses will burn out. More seniors will move into nursing homes. Others, whose lives might have been preserved, will pass on. And in the mid-to-long term, the state will pay more.
Washington is known as a model state for its efficient community-based long-term care system. Adult day health services are an essential part of that system. We created this system for a reason. Let’s not destroy it now, in the pursuit of illusory short-term savings.
Nancy Dapper is executive director of the Western &Central Washington State chapter of the Alzheimer’s Association. Nora Gibson is the executive director of ElderHealth Northwest.
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