Proposed California budget cuts threaten programs for Alzheimer’s patients

Her eyes sparkle and she flashes a flirtatious smile as a volunteer guides her across the dance floor.

Watching Adriana Trevino swing her hips to Mexican music at an adult day care program, it is hard to believe that a few months ago the petite 93-year-old in a spotted pink dress stared blankly at the world and dissolved into frequent, inexplicable bouts of tears.

Earlier this year, a neighbor introduced Trevino’s family to the California Alzheimer’s disease program, which runs 10 centers throughout the state offering treatment, support, research and education services to patients and their caregivers. Trevino’s son, Jesse, says the specialists he met there gave him back his mother.

“Now she is the life of the party,” said Jesse Trevino, who at 56 has become his mother’s primary caregiver and manages her Boyle Heights boardinghouse. “Put on some mariachi music, and she will kick it.”

Trevino is afraid that lifeline could be taken away. Among the cuts being discussed to close a projected $24-billion state deficit are proposals to dismantle many of the programs that help California’s poorest cope with Alzheimer’s. If approved, advocates for Alzheimer’s patients say, it would turn back the clock nearly 30 years to a time when the only option was a nursing home.

Gov. Arnold Schwarzenegger is proposing to shut down the state’s adult day healthcare centers, which provide services to help the elderly continue living at home. Also eliminated would be a program that funds Alzheimer’s care at these and other centers. The governor would end home care for all but the neediest, and eliminate programs that help families of the elderly navigate the complicated system of care and get some respite.

“We are talking about a devastation of the safety net for these families that wasn’t really robust to begin with,” said Debra Cherry, vice president of the Alzheimer’s Assn.’s Southland chapter. “Without any community support, these families are going to crumble.”

Schwarzenegger said he does not want to hurt patients or their families, but the financial crisis leaves him no choice but to make wide-ranging cuts.

Cherry argues that the presumed $385.8 million in savings would be wiped out within a few years if families have to put their loved ones in nursing homes for care subsidized by the state. And the state’s 100,000 nursing home beds would not be sufficient to accommodate a surge in demand from Alzheimer’s patients and an aging population, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services.

There are more than 588,000 Californians living with the disease, a number that is expected to nearly double by 2030, according to the Alzheimer’s Assn. The figures are even more dramatic for the Latino and Asian communities, in which the number of people living with Alzheimer’s is expected to triple.

Although the onset can be subtle, the disease can leave people feeling lost, confused and irritable. Ultimately, they must rely on others for such basic needs as preparing meals and taking baths. The Alzheimer’s Assn. estimates that about 80% of patients are cared for at home, which takes an emotional and financial toll.

For Adriana Trevino, the first signs were small memory lapses, nothing alarming for a woman then in her 80s. She would finish eating and announce it was time for lunch. Once she forgot she had already taken her pills and swallowed another handful.

Then the symptoms got worse. The woman who had kept friends in stitches with her sly asides was always in tears. She forgot how to wash and dress herself, became incontinent and lost her balance.

The family doctor said she suffered from dementia and suggested a nursing home. But her son and daughter wouldn’t hear of it. They tried medication. By January, their mother seemed like a zombie. She could no longer walk and was barely responsive.

In desperation, Jesse Trevino approached the Alzheimer’s Disease Research and Clinical Center at USC. Dr. Lon Schneider, who heads the center, said general practitioners rarely have the time or expertise to do a thorough diagnosis.

The center’s specialists concluded that Adriana Trevino had been overmedicated with tranquilizers and recommended the Boyle Heights adult day care program to keep her active and stimulated. They also got her on a trial for a promising new Alzheimer’s drug. Four months later, she is back on her feet, using a walker she refers to with a wry smile as her “Cadillac.” She readies herself for day care at the International Institute of Los Angeles, where a guitar player strums in a sun-splashed courtyard and she can play her favorite game: picture bingo.

She often refers to Monterrey, Mexico, where she grew up. Money was scarce, but her trim figure and sunny personality won her a job modeling clothes in store windows. The day she was married, she drove off with her husband to begin a new life in Los Angeles. He found work cleaning movie theaters and saved enough money to buy a rambling old house fronting Hollenbeck Park.

Now the income they get from renting out rooms -- about $18,000 a year -- is what keeps the family going. Her son once was a bus driver and taught aspiring musicians to play the bass, but he has not been able to hold down a job since taking on his mother’s care. Her only other income is a monthly Social Security check for $860.

According to the Alzheimer’s Assn., 69% of California caregivers have annual household incomes of $40,000 or less. Some have already been affected by reductions to Supplemental Security Income for the state’s most vulnerable.

Adriana Trevino relies on Medi-Cal to pay health costs not covered by Medicare. But Schwarzenegger is proposing to eliminate coverage for dental, vision and some nutrition services. The legislative analyst’s office, which advises California lawmakers, has suggested that all 10 Alzheimer’s Disease Research and Clinical Centers also could be eliminated. Although Schwarzenegger did not include them in his proposed cuts, staff members fear their program could still lose funding if the state can’t close the budget gap.

The day care program that Adriana Trevino attends in Boyle Heights depends on money from the Los Angeles Department of Aging. That funding was extended for three months in April. But program director Cecilia Chavez said she won’t know if the program can continue beyond June until the city knows what funds it will be getting from the state.

The uncertainty is agonizing for Jesse Trevino, who could not afford private care for his mother. “I have been blessed with the [resources] to bring mama back,” he said. “We would both be devastated if these got cut off.”

--

alexandra.zavis@latimes.com