Budget Cuts Threaten Latino Seniorsâ€™ Health, Safety

Araceli Martínez Ortega is the Sacramento correspondent for La Opinion in Los Angeles. This is the second of two articles written under New America Media’s 2010 Ethnic Elders Fellowship program sponsored by The Atlantic Philanthropies. You can read part one here.

The only thing that makes 82-year-old Jesús Ruiz happy, despite his disabilities and feeling abandoned by his children, is the help he receives from the State of California through In-Home Supportive Services (IHSS) for frail low-income elders and younger people with disabilities.

A home-care worker with a kind Mexican face goes to Ruiz’s apartment in Sacramento three hours per day to help him to clean, to wash his clothes and cook for him. She is the only one person left to care for him.

"She is a true angel,” said Ruiz, for the first time showing a smile in his face during the interview.

"If they take her away from me, I would rather that they hang me in a tree. What am I going to do? If my children turn out to be devils, and my neighbors are only smoking pot. Who is going to help me,” he asked with a tone of desperation.

With a heart condition and diabetes, Ruiz takes 15 pills per day. "The doctor has told me that I can go in any moment," he said.

Proposal to Cut Half of Home Care

Ruiz’s future and the future of 464,000 people enrolled in the IHSS program -- 20 percent of them Latinos -- is in the hands of the legislature and governor.

In his proposal to close a $19.1 billion budget deficit, Gov. Arnold Schwarzenegger plans to cut $637.1 million from IHSS -- half of the program’s budget.

"I clearly see the faces of those who are behind the numbers. I know how many people are suffering and how painful it would be, but we cannot promise what we cannot keep. These are the revenues that we have," said Schwarzenegger in justifying the IHSS reduction, during his May revised-budget presentation.

Advocates for seniors and people with disabilities say the cuts would place at risk the lives of low-income, sick and disable elders, among them more than 100,000 Latinos.

At best, the IHSS reductions might force many seniors to go to nursing homes. But experts fear that many of those who lose home care would be subject to injuries, hospitalizations and death. In the meantime, more than half of the 350,000 caregivers would lose their jobs, increasing California’s already high unemployment rate, which stands at 12.6 percent.

"There would be nothing to help elders in their communities, and we would go back 30 years if the cuts become a reality," said Steve Wallace, a professor at the University of California Los Angeles School of Public Health and an associate director at the UCLA Center for Health Policy Research.

Besides wanting to slash IHSS, Schwarzenegger proposes to close the state’s $19.1 billion budget hole in part by completely eliminating the Adult Day Care Centers (ADHC), which enables family members to drop a frail elder off in a safe place while they’re at work. These centers care for up to 47,000 elders.

Last year, the governor tried to cut IHSS and the ADHC, but two class-action lawsuits halted the cuts from taking effect until the legal actions can move through the courts. These severe reductions would affect around 150,000 elders, who suffer physical and mental disabilities, according to Ana Rich, an attorney with the National Senior Citizens Law Center.

Report: Cuts Will Really Cost More

California’s nonpartisan Legislative Analyst’s Office (LAO) estimated that 50 percent of those who could lose IHSS help--213,500 elders--could look for a place in nursing homes.

But a new report published by the Institute for Women's Policy Research and written by economist Candace Howes of Connecticut College found that 300,000 elders are likely to be displaced to nursing homes at an annual cost to California of almost $3 billion—far more than the cost of caring for elders at home.

Latino elders, unlike whites, tend to live with their families. Only 13 percent live in nursing homes, according to Wallace.

Ruiz said he applied to enter a nursing home but was place on a waiting list.

Sandy Vargas, 60, from Los Angeles, became wheelchair-bound after a brain hemorrhage paralyzed the left part of her body. She does not want to go to a nursing home.

"I was almost killed in one,” she asserted. “I would rather be cared for in my home. But if they take my [IHSS] workers, I am not going to be able to work. I cannot walk, dress or eat by myself. !Vamos! I cannot even can get up by myself," she declared, sounding terrified.

Wallace stated that nursing homes have a limited number of beds for Medi-Cal patients.

According to Wallace, if the state eliminates IHSS home support, which are covered under Medi-Cal (California’s Medicaid program), for more than 400,000 vulnerable people, only 5 percent—not 50 percent of them--could be placed in a nursing home.

That’s because the only other option for low-income people who qualify for Medi-Cal is a nursing home. But Wallace calculated that only about 20,000 beds would be available. More than nine out of 10 people cut off from home care would be left on their own.

“Where Will Elders Go?”

"Where will elders go?” ask Dr. Bruce Chernof, president of the SCAN Foundation, which focuses on long-term care issues. "Literally, there is no space for them and no extra help in their own homes. Even though these are hard fiscal times in California, without moderation these cuts would result in the abandonment of our more vulnerable elders," he stressed.

Because nursing homes are expensive, the state established the IHSS and community programs in the early1980s. A 2006 report found that keeping a disabled person at home is $44,000 less costly per year than sending the person to a nursing home.

In addition, Beacon Economics, an analytical research consultant, found that each dollar the state spends on IHSS, it generates an additional $5.44 in California economic activity, such as through matching federal dollars and the caregiver's salaries, which are paid by counties.

If IHSS were cut, who would lose assistance? Currently, the program’s recipients receive aid according to how many hours of help they need for 11 daily activities of living, such as laundry, cooking, shopping, dressing and cleaning. Service providers rate a person’s level of need from level one to the most severe at level five.

The governor’s proposal would provide home support only to those at the fourth and fifth levels and leave many with serious difficulties to fend for themselves. An analysis done by nine counties (Los Ángeles, Sacramento, San Benito, San Diego, San Joaquín, Santa Clara, Stanislaus and Ventura) established that many of the elders below the fourth level have substantial needs.

Norma Torres, D-Pomona, one of only two Latinos on the California Assembly’s Aging and Long-Term Committee, emphasized that the governor's proposal does not include a global and comprehensive vision of the problem. "His focus is to make immediate cuts. But he does not see that if we cut programs like IHSS, it will triple the current cost," such as by causing unnecessary hospitalizations and preventable emergency room visits.

Sadly, none of the candidates for California governor have released their plans for elder care.

Last April, 75 percent of the Latinos interviewed for an UCLA Center for Health Policy Research poll, said that home care and community centers should be a high priority for elected officials.