Cathy Cress

Expert in Aging Life and Geriatric Care Management

California Cuts Pushing Frail Elders into the Cesspools of COViD-19

Here in California, the frailest, poorest and oldest in the state are being potentially knifed in the back by slashing budget cuts to the very services that keep them out of nursing homes.

 The Multipurpose Senior Services Program , one of the first geriatric care management programs in the nation, designed to keep fail elders out of nursing homes, is set to axed from the California State budget.

The Governor has also proposed elimination of $2.9 million of state funding and $3.9 million in federal matching funds for the 11 statewide Caregiver Resource Centers, 

providing critical respite care and counseling to caregivers of adults with chronic and disabling health conditions.images_20130906-154817_1.jpg

Both programs were designed 4 decades ago to keep elders at home and out of more expensive nursing homes and staunch family caregiver burnout. They offer huge safety nets, designed to keep frail seniors in the community.

MSSP is of a daycare program providing rich social and health services to frail elders and their families. The Care Resources Program caregiver respite and support to overwhelmed family caregivers.

These programs save the state a bundle of money. Each of the MSSP clients is disabled enough to be eligible for nursing homes and poor enough to be eligible for MediCal. So instead of the state paying $80,000 or $90,000 per person per year in a nursing home, the State pays only on average a little over $5,000 for the person to be in GunnDadJacket.jpgMSSP.This makes the cuts both fiscally stupid and mystifying.

What California government is doing is ripping giant holes in this web plummeting 45,000 seniors into the cesspool of COVID-19 skilled nursing facilities, where almost  half of California COVID-19 deaths occured.

 Without the services and supports available through MSSP, and the Caregiver Resource Center, many older Californians will have no other choice but to be admitted to nursing homes, where nearly half of all deaths related to COVID-19 have occurred. 

But the doors may be barred. Given the high risk of COVID-19 in nursing homes, owners are reluctant to take new patients. So, the elimination of the Caregiver Resources Center and  MSSP is really a death sentence to frail elders. It leaves no fire extinguisher for caregiver burnout of the family caregivers who care for elders with the toughest disease: brain impairment- Alzheimer’s, stroke, dementia, Huntington’s disease, Parkinson’s other conditions that may cause memory loss or confusion.

This may cause a cascade effect- placement of these horribly demented elders, into the plague-infested nursing home or also to death’s doorKali--Bill-Connies-book-.JPG

Governor Newsome has been a national hero as the first governor to issue a stay at home order to close counties down in California. He slowed the spread of coronavirus and kept California in a safe zone compared to most other states. But this was at the cost of taxpayer dollars as 4.7 Californians were put out of work. 

 He finds himself in a double bind now with a chasm of a budget hole, that he is trying up to fill with cuts like the ones proposed to the senior program. But the cuts will lead seniors to nursing homes  costing $80,000 a year instead of the $5000 for MSSP  into those caldrons of coronavirus

California is always the canary in the coal mine- the innovator that most states follow. So, these cuts can be expected across the nationwide. Who is the real villain in these cuts, the Trump Presidency. 875 billion was approved in the House of representatives in the HEROES Act. Cutting both programs saves $119 million. But these cuts would be eliminated if Congress OKs this aid for state and local governments — a prospect many state lawmakers believe is unlikely as President Trump is threatening to veto the money to the states . This has spurred a cacophony of outrage from local legislators and senior advocates. angered state lawmakers from both 

major political parties who say it’s irresponsible in light of the coronavirus pandemic that has spread through nursing homes across the state. It’s one of many conflicts emerging this week as lawmakers hold public hearings examining Newsom’s proposal before they must vote on a spending plan by June 15.

Want to help save these programs

 

PUBLIC COMMENTS – WRITTEN: Submit written public comments by email to: sbud.committee@sen.ca.gov

How Important are Nurse Care Managers?

 

My husband Pete and our family have our own RN case manager.

Pete had open heart surgery 3 days ago at Stanford Hospital. The utility and utter comfort of having a care manager hit me personally on this health care journey.

Our Stanford Cardiac Care Manager

Stanford’s cardiac unit is a wonder to behold. Your family touchpoint is, of course, the care manager. She is your navigator, comforter in chief, and patient-friendly-dispenser of information framed in a  digestible synopsis.

In her warm yet filled with authority voice, our care manager Christine Harris RN BSN greeted us in pre-op and explained what would happen during the surgery. She soothed our fractured nerves. Facing open heart surgery was, as with all patients, like taking a long trip you researched well but never understand the whole journey nor the wrong turns you just might take. 

It had taken Pete 7 years to get to this point as he was one of a category of 2% heart patients that had no symptoms. He had not wanted to do the surgery and they respected his wishes. In the last few months, they found his heart not getting enough oxygen, so he finally decided to do it. The day before surgery he was chopping down a plum tree, among the many, in our California yard.

12 Hours of Open Heart Surgery

As the open heart surgery was 12 hours long- most of it pre-op and then post-op, Christina our care manager became our navigator through the long hours of waiting  She came to us at every stage, shared information that calmed us and made us feel health literate about what was happening to Pete.

Trouble on the Tracks

But in the late afternoon, when we were feeling so sure he was sailing through the procedure, we became alarmed. Stanford has a color-coded electronic screen of all patents in surgery showing you their operating stage. We were watching this large electronic surgery board, much like an airline flight board with scheduled take-offs and landings. Pete was about to land in post-op then before our eyes -reversed to the operating room. Pedro, the navigator of the board,  had no idea what happened but told us Christine would be down to talk to us. My two daughters and I were then on red alert and our lovefest with the ease of all this dumped back into reality.

Tear in the Heart

As any case manager would, Christine arrived with calming information. As they were about to close up Pete’s chest after the new valve went in flawlessly, they noticed a small tear in the aorta. She explained that the aorta, like all of Pete’s body, was almost 8o- years old and thin enough to tear. Dr. Fichbine saw bleeding, along with the  30 residents who were watching, did a small patch, closed up the incision then sent him on his way to post-op. In reality, it was more serious, but she shared the steps taken and he was in truth patched up and on his way to recovery. She gave us the right information mellowing it out enough that we went from Post  9/11 color-coded red- terrorist attack imminent —to calming green – low threat. Pete arrived back in post-op and we got to see him at 7:30 that night 13 hours after his trip through the surgical theaters.

Christine is also our head discharge planner and goes to see Pete every day, along with Dr. Fishbine on rounds. She will be there at discharge when she, a Stanford pharmacist, and a cardiac nurse share discharge plans.

So thanks to all the care managers who like Christine, guide us over troubled waters, comfort us and hold our hands while they navigate us to a safer shore.

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