Kenny Burton, 61, slowly picks out the yellow plastic jewelry beads and puts them in his clenched left hand until he gets to a green one. He stops, looks at the colored beads spread out on the tray before him and begins sorting the blues.
When he was 19, Burton was in a serious motorcycle accident that cost him a 3-square-inch portion of his brain. He has no short-term memory, can't speak, is prone to seizures and for most of his life has needed someone to care for him - a task that fell primarily to his mother and twin brother before they died.
Today, that help comes from a team of occupational and physical therapists, nurses and nursing assistants at Sonoma County's only adult day health center. In the company of other seniors, some of them with Alzheimer's or stroke victims, Burton has found a place of his own.
"When he walks in the door, I get so emotional about it," said Burton's sister Hazel Bishop, 63, of Fulton. "Those are his friends, the people that relate to him, and I'm only a visitor. I'm in his community; he's not in my community and that gives him a sense of worth that he's not had for a long time."
This week, Bishop was told the adult day health program, located for decades at the Friends House campus in Santa Rosa's Rincon Valley, will be closing in mid-July because of state budget cuts. The news has sent her and other clients' family members into a panic about what to do since there is no other adult day center in the county that offers health care services.
State funding for such programs has been threatened for years, and in March 2011 the state Legislature voted to eliminate Adult Day Health Care, or ADHC, as an optional benefit under Medi-Cal, the state's Medicaid program. The community-based program is aimed at keeping low-income, frail seniors and disabled adults from being put into skilled nursing homes or other residential institutions.
Two months later, about a half dozen adult day health clients asked for a preliminary injunction in federal court to stop the elimination of the program. Attorneys for the adult day health clients argued that the state's move violated the due process clause of the 14th Amendment of the U.S. Constitution, the Social Security and Americans with Disabilities acts, as well as other federal and state laws.
Elimination of the program, which serves 35,000 people across the state, without replacing it with adequate services would put many at risk of being placed in an institution, they argued.
Before the case reached a court hearing late last year, the parties reached a settlement. Under the agreement, adult day health clients would be switched from Medi-Cal to a new program called Community Based Adult Services.
But there was one catch. Adult day health programs that were operated by federally qualified health centers would no longer get the enhanced Medi-Cal reimbursement on which they relied so heavily.
The Rincon Valley program is operated by one of them, the Santa Rosa Community Health Centers. Its daily reimbursement before the settlement was between $150 to $170 per person, said Naomi Fuchs, executive director of the health centers.
Under community-based services, the reimbursement is $78. The loss was more than the health centers could cover.
"Since April, we've been losing $50,000 a month on this program," Fuchs said. "We can't go on losing $50,000 a month forever. This is a tremendous loss for the community, and we are so sorry."
Of the 38 current clients, 25 were covered by Medi-Cal and 13 were "private pay" clients, said Susan Beer, a registered nurse who runs the program.
For some family members, the closure was expected.
"No, I was not surprised, but I was devastated," said Marie Truman, whose husband, Chuck, 66, was diagnosed with Alzheimer's five years ago and has been a client at the center for about two and a half years.
Truman's husband is at the center three days a week, from 10 a.m. to 2 p.m. His time there allows Truman, a Weight Watchers lecturer, to work four of the 11 weekly meetings she conducts.
"I have to have 11 meetings to get benefits," she said. "I am not on Medicare. I'm paying for medical benefits."
Truman's husband is one of several clients whose care is covered by Department of Veterans Affairs benefits program. Truman said that although the state reimbursement reduction does not affect her husband's benefits, she now has nowhere in the county to take him.
"The program is important to both of us," she said. "To him, because it makes him socialize with other men his age and men who are older. Some are vets also, so they have something in common to talk about."
The $78 reimbursement is sufficient to operate an adult day health program, said Jane Ogle, deputy director of health care delivery systems for the state Department of Health Care Services. Of the 300 adult day health programs in the state, only a handful are operated by federally qualified health centers, she said.
"We decided that a center is a center, and the amount of money that it takes to run a center is $78 (per patient, per day) not $170," she said.
But Beer and Fuchs said that the health services provided at the Rincon Valley site, which employs about a dozen health care workers, are extensive and unique in the county. The same care cannot be found at local senior centers or adult day programs.
Gary Fontenot, section manager of the Adult and Aging Division in the county Human Services Department, said adult day programs are not equipped to care for people like Chuck Truman or Kenny Burton.
"The impact could be these are people that have such high-level needs, they may have to go to a nursing home," Fontenot said. Those who can pay for in-home support may be able to avoid such a scenario, he said.
"The real loss is that we now have no adult day health in Sonoma County," he said.
In 2008, Vickie Jackanich's husband, Richard, suffered a stroke that left him dependent on her. He also is diabetic and requires bathroom assistance through the night.
Jackanich, 63, takes her 82-year-old husband to the adult day health program two days a week. It's a period of time that allows her to do errands or something "for myself."
He is a former physician who had the foresight to plan for his old age, and years ago he purchased a long-term nursing care plan. But the center will be gone.
"I'm going to have him around the house," she said. "We're still a couple. We'll still work things out. But it's going to be a great loss for him. He's going to be real sad I just know that."
(You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com)
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