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Last updateTue, 18 Sep 2018 1pm

Rob Lyman of didn’t know what to do.

The Redwood City resident was helping his aunt, Sharron Evans, who had early-onset Alzheimer’s disease and needed constant supervision. A former teacher, she had run out of money and had no income. She qualified for government health-care assistance, but it appeared she’d need to go to the only setting that would be covered: a nursing home.

“Basically, that’s a hospital setting, and that was our only choice,” Lyman said.

To him, that didn’t make sense.

“My aunt just needed a safe place to be; there was nothing physically wrong with her,” Lyman said. “She didn’t need that level of care. It’s inappropriate. It costs the state a lot of money. But this is what people do. That’s the default choice.”

The baby boomers are aging. By the end of the next decade, 11.1 million Californians will be 60 or older, and the number of people 85 and older will jump 37 percent, to the 1 million mark, according to state officials. One in six Americans is expected to develop dementia, and care can be expensive enough to force even middle-class families into poverty and onto the public payroll.

For low-income seniors who can’t afford care at home and don’t need the full medical services of a nursing facility, the state’s few options aren’t enough to meet demand. A middle-ground choice—assisted living—requires special permission under government rules and is available to fewer than 4,000 Californians, although state health officials and lawmakers are both proposing increases. Taxpayers currently pick up the more-expensive nursing-home tab for more than 20,000 people who may not need it, by one advocate’s estimate.

Evans, now 69, was lucky enough to land a permitted spot in a Sacramento-area assisted-living home after nearly a year’s wait. The cost didn’t matter much to her or Lyman, because it was paid by Medi-Cal, the state’s version of the federal Medicaid program. The lower price tag for assisted living saves the state money, while also providing a more home-like setting and the right level of care for Evans.

For more than a decade, the state Department of Health Care Services has been trying to address the need for more-appropriate, less-costly care. But Medicaid pays only for what is “medically necessary,” such as nursing-home care, unless states ask for waivers. The state budget deal struck last week would provide administrative costs for a waiver to cover an additional 2,000 assisted-living slots.

That’s not enough, said Assemblyman Ash Kalra, a Democrat from San Jose. Kalra’s Assembly Bill 2233 proposes adding nearly 13,000 more, to cover a total of 18,500 people over the next five years. That would basically triple the number of Medi-Cal recipients with access to assisted-living care—assuming waivers, which last five years, can be secured.

“We’re hitting a crisis point with our senior care,” Kalra said. “It costs us twice as much for skilled nursing care.” His bill, which has no organized opposition, passed the Assembly and is now in the Senate.

The federal and state governments each pay roughly half of Medi-Cal expenses. A legislative staffer pegged savings for the state’s share at slightly more than $23 million over the five years, once all 18,500 patients are placed in assisted living. According to the Department of Health Care Services, which oversees Medi-Cal, the state’s share of the average cost for assisted living is about $22,000 a year per person—roughly half the $42,000 annual cost of a nursing-home.

“I have visited skilled-nursing facilities, and the nurses … told me that many of the patients don’t need that level of care. So we could be saving money for the state dramatically,” Kalra said.

According to the Department of Health Care Services, California has about 53,000 Medi-Cal patients in long-term institutional care, such as skilled-nursing facilities. A legislative analysis shows an estimated 11,000 of them have lower-care needs and could be fine in assisted living.

That figure could actually be twice as high, said Mark Cimino, who runs assisted-living homes in the Bay Area and around Sacramento, including the one where Evans lives. He said assisted-living facilities provide a wide range of care that could serve upward of 20,000 Medi-Cal patients who are now in nursing homes.

California’s first waivers, approved in 2004, covered about 1,000 people. That figure doubled in 2009 and nearly doubled again to about 3,700 in the most recent period, which runs out in March 2019.

“There’s a huge trajectory here,” Cimino said. “The question is: Is the expansion of the waivers enough?”

And there’s the human side of the equation, he added: “The assisted-living community is more home-like,” he said. “No one wants to spend much time in a (skilled-nursing) unit.”

The state “has specifically worked to expand access to assisted-living services,” said Department of Health Care Services spokeswoman Carol Sloan.

It’s hard to go any faster, she said by email, because the state has to check for “requirements, monitoring and oversight responsibilities, staffing, adequacy of available provider network and other resource limitations” before requesting more waivers.

As for the nursing-home industry: “If a resident can be shifted to a lower level of care, we think that’s a good thing,” said Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade group. “We always support people getting the appropriate level of care for their needs.”

That won’t hurt business, she said: “The boomers are coming.”

For Rob Lyman, a move toward assisted living is a no-brainer.

“If the state, and we as a community, are going to provide assistance, we have to do it in a cost-effective way,” he said. “Putting people in skilled nursing when they don’t need it—that’s not good stewardship of public dollars.”

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

As the turbulent year of 2017 churns toward its conclusion, you may be looking for a place to grab a dose of the Christmas spirit.

I found a place—the Mizell Senior Center in Palm Springs, which administers the Meals on Wheels program for the Coachella Valley.

“We just put our Christmas ‘giving tree’ up,” said Ginny Foat, the executive director of the center. “Our Meals on Wheels drivers—who are professionally trained full-time employees and not volunteers—come back from their routes and give us the names of clients who are just really poor. We sent each of those poorest clients a flier asking them what they wanted for the holidays. When they send us their wish list, we attach them to ornaments which we hang on the ‘giving tree.’ Then, people voluntarily come and pick an ornament and go out and buy specifically for that one person. The kind of lists we get are for books, stationery, electric razors, socks, slippers or new blankets. We never get lists asking for perfume, jewelry and computers. It’s really heartwarming to see all these people voluntarily come take the ornaments off the tree, and then come back with all these wrapped presents that we deliver to client homes on Christmas Eve.

“Another thing we do is deliver holiday bags to every single one of our clients that are filled with items donated by the community,” Foat said. “In the beginning of December, we collect toiletries, socks and other essentials, and then we deliver a huge bag of stuff to each client right before Christmas.”

To the staff of 23 people who enable the Mizell Senior Center’s Meals on Wheels program and provide year-round nutritional support to the neediest seniors living throughout much of Riverside County, generosity of spirit and acts of caring are a way of life every day.

“Our nutritional program has two initiatives: the congregate sites where people come in and have lunch together at different sites that we handle, and then we have the home delivery (via Meals on Wheels),” said Laura Castillo, the director of nutrition and operational services. “… Through Meals on Wheels, we deliver some 465 meals per day. Both the congregate sites and our home-delivery clients range from Whitewater to the west, and all the way east to North Shore, Mecca, Thermal, Coachella and Indio, as well as Cathedral City, Desert Hot Springs, (other area cities) and two senior communities in Palm Springs, along with our Mizell Center here. Also, we’ll probably start serving Palm Desert’s Joslyn Center at the beginning of our next fiscal year (July 1, 2018).”

Along with these primary responsibilities, the Meals on Wheels team does other things that aren’t necessarily in the job description.

“Sometimes, our delivery drivers are the only person who our clients will see in the whole day,” Castillo said. “That’s part of what makes this program so great. Yes, it gets hectic and frustrating when there’s not enough of this or that, but the support this program gets from the Mizell Senior Center itself is huge. It’s become such a great community.”

The requirements set by Riverside County for participants to qualify for Meals on Wheels service are strict.

“You have to have no one in the house who can cook or go to the grocery store,” Foat said. “You need to have no means of transportation.”

Whether or not a client can qualify for Meals on Wheels, the center’s staff is always looking for ways to improve every senior’s life.

“If a client can find a way to come into the center to get their meals, we encourage it, because they’ll make friends and have a motive to come out of their homes,” Castillo said. “I had a client two years ago who didn’t want to leave his house. I told his kids, ‘He’s mobile, and you need to get him to come to the center.’ So finally, his kids got him to come. Then, six months later, I hadn’t seen him for awhile, so I called the family, and they told me that he was in Oregon. When he came back at the end of the summer, I found out that he had married one of our other clients who he met here at the center. That was so cute. So, it’s a social program. It really is.”

All these good works require a lot of funds—funds that aren’t always readily available.

“Right now, we’re under-budgeted (for the volume of service we provide),” Castillo said.

Foat said Mizell’s Meals on Wheels program never lets any eligible senior go hungry.

“One of the things I think is so unique about our program is that we serve one-third of the (Meals on Wheels) in Riverside County, but we are the only purveyor for the county that does not have a waiting list,” Foat said. “Others start a waiting list each year when the county funds run out, but we fund-raise. This is a hard thing to do, but our board has decided that food is the most important thing for anyone, since without food, you can’t exist. You can’t do anything. So we’ve committed to never having a waiting list, and we have to fund-raise constantly to support this ideal.”

The Riverside County contract supplies the center with not quite 80 percent of the funding required. That means Mizell’s staff and board need to raise the money to subsidize 20-plus percent of the total—or the cost of roughly 34,000 meals, plus the cost of 20,000 extra meals that are not subsidized by the county.

“This year, because the county funds were much reduced, we’ll probably be looking at 50,000 meals that we’ll have to raise the money to pay for,” Foat said. “But it’s so important, since a lot of the clients that we deliver to are so dependent on that meal. Without it, they would not be eating.

“Also, another good part of our program is that we deliver pet food to seniors who have pets. We partner with the Palm Springs Animal Shelter pet-food bank, and twice a month, we deliver either cat or dog food, because we found that sometimes, our seniors’ only companion is their pet.”

To donate money to the Mizell Senior Center and its Meals on Wheels program, visit www.mizell.org, or drop off a check at the center, at 480 S. Sunrise Way, in Palm Springs. To donate essential goods for holiday gift bags or participate in the “giving tree” effort, simply stop by the center.

Below: The Mizell Senior Center kitchen staff: Kelly Wills (executive chef), Laura Castillo (director of nutrition and operational services), Mike Williams (kitchen assistant 1), Pedro Hernandez (kitchen assistant 2), Steve Bautista (sous chef), AJ Pelen (kitchen assistant 2), Irma Hernandez (kitchen assistant 2), Keith Strother (volunteer) and Mindy Burnett (cook).

Published in Features

It isn't really my bag to write about bags, but it's not easy being green when you have to answer questions like, "Paper or plastic?"

The Palm Springs Sustainability Commission has been researching the idea of a plastic-bag ban in the city. Dozens of cities and counties across California have already adopted plastic-bag bans, and Palm Springs would be the first city in the desert to follow their lead.

In other cities where a plastic-bag ban is already in place, there is also fee of 10 to 25 cents per paper bag. The idea is that adding a charge for paper-bag use will also help encourage people to switch to reusable bags. The only drawback would be the tendency for reusable bags to harbor bacteria, so the public would have to get into the habit of washing them periodically.

There are a lot of things we can do here in the valley to help the environment, and our large population of senior citizens is just the group we need to help us accomplish this goal. Our country has a history of putting elderly people out to pasture, and this attitude cannot be tolerated. We need to give these seniors a feeling of usefulness so they can continue to contribute to society. The most efficient way to do this would be to replace all the plastic bags with our beloved old bags. There are plenty of old bags in the area who would be more than happy to assist in this effort. There could even be an organization dedicated to making these seniors available to the public called, "Bunch Of Old Bags Interested in Earth's Survival," or BOOBIES for short.

If someone needs to go shopping, they can enlist the help of one of these BOOBIES to carry the groceries for them. The BOOBIES would also have a reusable clause in their contract so they can be called upon again and again for their services. However, it would be the shopper's responsibility to wash these reusable old bags to prevent any bacteria from spreading.

Unfortunately, plastic bags aren't the only threat to the environment. We also have a severe water shortage here in the desert. There are 66 golf courses in Palm Springs. On average, each consumes more than a million gallons of water per day.

So what can we do about the situation besides asking our local Native Americans to perform a rain dance? The solution lies in raising money to build a reservoir, and there's no better way to do this than to have a benefit concert.

The Doobie Brothers could perform their hit song "Black Water" for the occasion. While the Doobies are singing, the BOOBIES could pass out bags for donations.

Let's not forget one of the most important ways to be green. Everyone needs to do their part to save electricity. The desert is the perfect place to utilize solar energy. Our never-ending supply of sunshine makes it a no-brainer. That's why famous no-brainer George W. Bush should be appointed to assemble a solar panel to study solar panels.

Can you imagine a world with no plastic bags, plenty of fresh water, and unlimited electricity? It may sound like a fairy tale, but as Frank Sinatra would say, "Fairy tales can come true, it can happen to you, if you're young at heart." That would include all of our young-at-heart old bags, of course.

Lights out.

Published in Humor