Marin Adult Day Health Center in Novato — the only such site in the county — is closing, leaving 36 clients with no alternative program.
Jackie Phelan, of Fairfax, said she received the news recently after trying to arrange for her husband Charlie Cunningham, 74, to be cared for there. He suffered a traumatic brain injury in a bike accident in 2018.
Phelan, 67, and her husband visited the center in October and filled out paperwork. But they heard nothing from Lifelong Medical Care, a federally qualified health center in Berkeley, which took over the center in 2008.
“I’ll be calling regularly every week to ask if there are any setbacks,” Phelan said. “I got no response.”
Meanwhile, she placed her husband in a long-term care facility in San Anselmo.
“He’s always happy to see me and hopes to come home, which I don’t think is realistic because I can’t afford that kind of care,” Phelan said. “It’s been a long, hard eight years. I’m burned out.”
Adult day services provide an alternative to nursing home care for people who do not need 24-hour skilled nursing. They allow caregivers, often family members, some time to rest or do other things while allowing their loved ones to stay at home. Marin Adult Day Health Center picks up participants in the morning and then takes them home in the mid-afternoon.
Kari Beuerman, assistant director of the Marin County Department of Health and Human Services, said Lifelong did not notify the county of plans to close the center.
Sylvia Hackaz, the company’s director of development and communications, disagrees.
“We notified the county only after we talked to our staff and participants,” he said. “I don’t think this will come as a surprise, as we reached out to them a year ago to let them know we were struggling to continue supporting the site. Unfortunately, there were no funds available to help them.”
David Vliet, CEO of Lifelong, said the board of directors decided to close the center on February 28. Clients and their families were notified of the closure plans on March 21.
An email LifeLong sent to “community partners, neighbors and friends” said, “This heartbreaking decision was made because the center’s financial sustainability is no longer viable for LifeLong. This comes after years of rising costs and loss of funding that historically supported the center. “
“We carried the center as long as we could,” Vliet said. “This was not a decision that was taken lightly.”
Beuerman said that for six years, from fiscal years 2011-12 to 2017-18, Marin County transferred $125,000 annually it received from Partnership Health Plan of California to Lifelong to support the center’s operations. Partnership HealthPlan of California, based in Fairfield, manages health care for Marin residents who qualify for Medi-Cal.
Jonathan Logan, a Marin Community Foundation co-president, said the foundation donated to the center from 2012 to 2018. Logan said the aid amounted to about $40,000 a year from 2015 to 2018. He declined to say what level of support the foundation is providing. Prior to that.
As for why the foundation stopped funding the center in 2018, Logan said, “The foundation periodically changes its strategic plan and direction. Different initiatives have different life cycles and so the cycle ends for this particular initiative.”
Lifelong, which was founded by the Gray Panthers in 1976 as a health center for people over 60, operates 14 primary care health centers, four dental centers, four school-based health centers, an supportive housing program, mental health services and urgent care centers. by doing .
Lifelong’s 2022 annual report said it expects to open a new health center in Berkeley this spring and a new health center in East Oakland sometime this year. According to the annual report, Lifelong had more than $122 million in revenue in 2021, including nearly $45 million in grants, and ended the year with more than $4 million in expenses.
But Vliet said Lifelong’s financial health isn’t as rosy as that report might indicate.
“Covid had an impact on us,” Vliet said. “Costs have gone up. Volumes were not what they traditionally were in the past. We are currently running a significant structural deficit.”
LifeLong served 56,612 patients in 2022, most of whom were low-income people of color. Before the start of the COVID-19 pandemic, Lifetime served 66,681 patients.
Vliet added that Lifelong’s labor costs have increased substantially. Most patients receive Medi-Cal and government reimbursement is inadequate, he said. The East Oakland Health Center project is on hold.
Vliet said the Marin Adult Day Health Center has been operating at a substantial deficit for several years. Losses have totaled more than $2 million over the past five years, and a $600,000 loss is projected for the next year.
“ADHC is an expensive program to administer,” Vliet wrote in an email. “Medi-Cal reimbursement does not cover costs; we are a small center, so there are no economies of scale; enrollment has declined rapidly during the pandemic; and we have not been as successful in securing grants as in the past.”
Debbie Toth, chief executive officer of Choices in Aging, a nonprofit that operates adult day health centers in Pleasanton and Antioch, said the Marin center is one of many around the state to close.
“Our industry infrastructure is collapsing because we don’t have the funding to meet the regulatory requirements of service delivery,” Toth said. “That’s the last row.”
Toth said state staffing requirements for adult day health centers mirror those for skilled nursing sites.
“We have to have the same medical director, pharmacy consultation, psychiatric consultation, nurse, social worker, physical occupational speech therapy, registered dietitian, and then we have activity coordinators, professional activity workers and professional care providers,” Toth said.
Vliet said the marine center has 20 employees.
Most patients at adult day care health centers are eligible for Medi-Cal. But Toth said Medi-Cal managed care plans, such as California’s Partnership Health Plan, can essentially set the rates they pay for adult day care because it’s considered an optional benefit and has no legal minimum payment.
Vliet said Partnership HealthPlan approved a $100 per day Medi-Cal reimbursement rate for clients at the Marine Center where the current cost is $345 per day. He said the Veterans Administration, which is supposed to pay for three participants in the Marine program, has paid for only one day care since 2020.
Dustin Lida, a spokesperson for Partnership Health Plan, said, “It is with regret that Lifelong Marine Adult Day Health Center is closing.
“The Partnership will not speculate on the specific factors that led to the decisions made by MADHC,” Lida said.
“We prioritize institutional care over community-based care in our policies and our funding,” says Toth. It’s a broken system.”