‘I Don’t Know What I Could Do for My Mother Now’

Marta Jimenez prefers to think of her mother in better times--as an airy, cheerful presence caring for her grandchildren, happily doing the household chores, tending the flowers outside the family apartment. Not the ghostly, disoriented figure who today shuffles through an El Monte nursing home in her stocking feet, sometimes failing to recognize her eldest daughter.

“It hurts me deeply to see my mother as she is now and I pray to God that he will take her,” a tearful Jimenez said in the lobby of the sterile facility that her mother, an Alzheimer’s patient, calls home.

Now, Jimenez, having finally made the difficult decision to institutionalize her 75-year-old mother this summer, is bracing for the shock of having her mother evicted.

Her mother, Francisca Echeverria, is among the hundreds, perhaps thousands, of elderly and disabled illegal immigrants nationwide who face a loss of federal benefits under the sweeping overhaul of the nation’s welfare system signed by President Clinton last month. The new law makes them ineligible for long-term care benefits under Medicaid, the public insurance plan for the poor. Without Medicaid, known as Medi-Cal in California, most will face ouster.

*

The uncertain fates of these nursing home patients are among the most poignant tales to emerge in the wake of approval of the law, whose ramifications are still not fully understood. During congressional debate, little discussion focused on the prospect of elderly and disabled patients being thrown out of nursing homes.

Ironically, the potential crisis has created a rare arena of agreement between Gov. Pete Wilson and immigrant advocates. Both sides say something should be done to care for this population.

Jimenez, who supports two school-age children on a meager salary earned cleaning houses and offices, cannot afford the $3,000-a-month nursing home price tag. It is a challenge just meeting her family’s basic bills, including the monthly rent of $600.

“I don’t know what I could do for my mother now,” said Jimenez, adding that she would probably have to quit work and become, in effect, a 24-hour nurse, enlisting the support of her children to help. “I guess I would have to lock her in a room for her own safety.”

The long-term care population affected by the new law is in need of skilled nursing supervision on a 24-hour basis, though their conditions may vary greatly. Most are elderly, but some are younger victims of debilitating illnesses or accidents. Some have families capable of assisting with their care; others have no responsible relatives, here or in their homelands. Some may end up on the streets and in emergency rooms--at much greater public cost, argue activists working on behalf of nursing home patients.

“Potentially, this could become a catastrophe,” said Pat McGinnes, head of the California Advocates for Nursing Home Reform.

Wilson, widely assailed in some quarters for his high-profile targeting of illegal immigrants, has vowed to seek alternative funding sources to maintain care of this vulnerable population. The governor made this exception even as he issued a sweeping executive order in response to the new welfare law, directing state agencies to begin the process of cutting off illegal immigrants from myriad state-funded programs, from breast cancer detection to post-secondary education to the issuance of licenses and contracts.

“We’re looking at other options to try and make sure these people do receive the care they need,” said Burt Cohen, assistant secretary of the California Health and Welfare Agency.

But no one knows where the money will come from, underscoring the lack of easy solutions to this dilemma. Advocates are hopeful that many undocumented residents receiving long-term care could be categorized as “emergency” cases--the only federal Medicaid category now open to illegal immigrants. Whether that approach will fly is uncertain.

For its part, the multibillion-dollar nursing home industry is also alarmed about the prospects of mass evictions, a loss of Medicaid revenue--or being stuck with nonpaying clients.

Looming over the entire issue is the likelihood of protracted litigation. Civil libertarians have vowed to be in court swiftly in an effort to block any benefit cutoffs.

The new welfare law’s extensive targeting of immigrants, both illegal and lawful, is illustrative of how, since the emergence of Proposition 187, lawmakers keen to reduce immigration have increasingly focused on benefits.

“The fact is, there’s not enough money in this country, period, to provide for all the needs of the rest of the world,” said U.S. Rep. Elton Gallegly (R-Simi Valley), who heads the Congressional Task Force on Immigration and has spearheaded congressional efforts to deny public education to illegal immigrant youngsters.

But even Gallegly acknowledges that government has a “humanitarian” responsibility in the case of those too infirm to survive on their own and lacking family members who can provide for them.

Those illegal immigrant patients who can be treated and safely moved, Gallegly argues, should be cared for until healthy and then “personally escorted back to their country of origin.”

The new welfare law contains no deportation provisions. But the statute does require that states notify the U.S. Immigration and Naturalization Service of the names, addresses, and “other identifying information” on anyone who state authorities know is in the country illegally.

California authorities are just beginning the process of identifying nursing home patients at risk of eviction.

*

To date, officials have estimated that about 200 illegal immigrants in California nursing homes face a Medicaid cutoff for long-term care. According to official estimates, which critics call inflated, they cost taxpayers $10 million a year from an exclusively state-funded Medi-Cal account set up in 1988 to finance restricted care for illegal immigrants, who are generally barred from receiving federal Medicaid monies. The new welfare law goes a step further, largely barring states from providing services to illegal immigrants.

However, experts say the number of nursing home patients facing ouster is likely to be higher than 200, possibly by several orders of magnitude. That is because the state estimate does not include many other long-term care patients--both illegal immigrants like Jimenez’s mother and others in quasi-legal status--who face a Medicaid cutoff under a little-noticed provision of the welfare law.

This group has been determined to be in the United States “under color of law,” usually because of pending petitions before the INS. But the new welfare statute categorizes much of this population as “unqualified” immigrants and deems them ineligible for nonemergency Medicaid.

“There are going to be a lot more than 200 nursing home residents in California facing a loss of Medicaid,” said Josh Bernstein, Washington policy analyst for the National Immigration Law Center.

Moreover, the new welfare law gives California and other states the option of cutting off most Medicaid benefits for a much larger group--legal immigrants--including those in nursing homes, after Jan. 1. State authorities say they are examining all options.

The timing of any prospective evictions of illegal immigrants from nursing facilities remains murky.

Once potential evictees are identified, however, strict notification requirements and appeal rights come into play. Anyone being cut off from Medi-Cal must be given 10 days’ notice and is entitled to a hearing, said Herbert Semmel, staff attorney with the National Senior Citizens Law Center in Los Angeles. Moreover, federal and state laws mandate that nursing home residents receive 30 days notice before being evicted.

Unfortunately, Semmel said, many residents and relatives are unaware of their rights. Language difficulties and a lack of understanding of the details of benefits law compound matters.

“Some of these people getting notices won’t have any family involvement; they won’t be capable of understanding what is happening to them,” Semmel said.

*

For Marta Jimenez, a single mother who has worked hard all her life, the legal intricacies count for little. What she knows for sure is that the clock is ticking on her mother’s time in the nursing home.

“If there is an ultimatum that she must leave, then I will take her home,” said a resigned Jimenez, 52, who arrived from Guatemala 31 years ago and has never gone back. Two months ago, she became a U.S. citizen--hoping, in part, to help her mother get her papers.

Her greatest fear, Jimenez says, is that her mother will be deported. “In Guatemala, my mother would just be thrown away,” says Jimenez. “There you only live well if you have money. At least here, even if you clean houses for a living, you can live decently.”

Her mother was arrested after she sneaked across the border from Tijuana in 1979 en route to her granddaughter’s wedding in East Los Angeles, say Jimenez and the family attorney, Janet Morris of Bet Tzedek Legal Services, a Westside firm that assists immigrants. But Morris said the INS never pursued the case, apparently because the agency lost the paperwork.

Her mother was a great help for many years, Jimenez says, recalling how she took joy in cooking meals, sewing, caring for her grandchildren, cleaning the house. But, about four years ago, Jimenez began to notice odd behavior: Her mother gave away two pet parrots, cages and all. She put sugar in food instead of salt. She regularly left the gas stove on. Soon, her mother was wandering off on her own--on one occasion police found her miles away the following morning, sleeping on the street.

Although her mother was found to have Alzheimer’s disease, Jimenez resisted the painful step of putting her in a nursing home until this past July. The dedicated daughter frequently visits the sparse room that her mother shares with another elderly woman.

On a recent, sun-splashed morning, Jimenez found her mother pacing through the nursing home’s halls, past rows of residents in wheelchairs, napping or staring vacantly into space. Jimenez had difficulty concealing her tears. Her mother, her gray-black hair disheveled, whispered to her in Spanish, “Don’t worry. With God’s help, all will be better one day.”