Lifeline of adult day healthcare may snap for some

At the Graceful Senescence adult day healthcare center in South Los Angeles, the average day is filled with music, art classes and exercise.
(Mark Boster / Los Angeles Times)

At 10 a.m. sharp, the central room at the Golden Age center started thumping with rap music. Staff members scurried around, urging everyone to set aside their cards and conversation.

“Exercise time! Exercise time!” the activity coordinator shouted as she began marching in place. “Up, up! Arriba, arriba!

Gilberto Hernandez wheeled himself to the front of the room and took his place in a semicircle of wheelchairs. His left arm remained limp, but he lifted his right arm into the air and moved it in circles to the beat.

Hernandez, a former construction worker left partially paralyzed by a stroke and heart attack 12 years ago, needs help eating, bathing, changing and going to the bathroom. Each weekday, he and about 130 others spend several hours at the Golden Age Adult Day Health Care Center in Lynwood.


“When I am here and listen to the music, I forget about my problems at home,” Hernandez, 48, said with a slur. “In my home I feel very alone.”

Hernandez isn’t the only one who relies on the center, decorated with brightly colored balloons and Valentine’s Day coloring sheets. While he is here, his wife, Emiliana, gets a brief respite from her duties as his caretaker.

Under the most recent cost-saving budget proposals, 327 adult day healthcare centers throughout California would be eliminated. Cuts could save the state $135 million in fiscal 2011, state projections show.

But advocates and center operators said care for many of the 37,000 low- income participants -- who suffer from diabetes, brain injuries, dementia and other chronic conditions -- would cost the state even more money if the centers close. More than 40% of participants would end up in nursing homes, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services. Others would be hospitalized.

Missaelides and nearly 20 others testified at a recent state Senate budget committee hearing in Sacramento against the elimination of the centers, which could occur as early as March 1.

“We are taking this extremely seriously,” she said. “We are in as much danger as we have ever been.”

Medi-Cal pays the vast majority of a center’s care costs, which run about $76 per person per day, Missaelides said. The average age of a participant is 78, but centers serve centenarians as well as people in their 20s. All centers have nurses, dietitians, social workers and occupational, speech and physical therapists.

Eliminating adult day healthcare services would affect family members as well as participants, operators said.

“They would have to figure out how to take care of their family members,” said Cástulo de la Rocha, chief executive of AltaMed Health Services Corp., which runs Golden Age and seven other centers in Southern California. “It would impact their jobs.”

Emiliana Hernandez said her husband is more relaxed and less depressed after spending the day at the center.

At Golden Age, he sings, dances, plays bingo, attends church and chats with his friends -- activities that take his mind off his life before becoming disabled.

Closing the center, Gilberto Hernandez said, “would ruin me.”

He dabbed the drool on the side of his mouth with a towel tucked into his shirt as he prepared for a physical therapy session. Therapist Charlie Evans maneuvered the wheelchair in between two bars and braced herself so she could help Hernandez lift himself up.

“You ready?” she said. “Take your time. One . . . two . . . three. Lift. Breathe in. Breathe out.

“Good! You got to do that four more times,” she said. “It will help you stand up for your wife.”

One morning at another center, in South Los Angeles, staff members welcomed participants and took their vital signs. Paper snowflakes hung from the ceiling. Aretha Franklin could be heard softly in the background. A sign at the front said, “Graceful Senescence -- Where Seniors Are Celebrated.” About 60 “young men and women” come to the center each day, said program director Nina Nolcox.

Adelina Lindo, 98, who has dementia, wore a plastic apron over a lavender sweater and bluejeans. A nursing student fed her French toast with a plastic spoon. Lindo stared into space, communicating by nodding and shaking her hand. Lindo’s great niece Adelina McCloud said she might have to put her in a nursing home if the center closed.

“I would do the very best I could,” said McCloud, a single mom studying to be a nurse. “But who would watch her while I go to school?”

Another participant, Dorothy Greenwood, her silver hair pulled back in a bun, arrived just after 8 a.m. and greeted a staff member enthusiastically.

“Good morning, baby,” she said. Her daughter Mary Nonnette kissed her cheek and jumped back into the car, running late for her job as a hairdresser.

When Nonnette, 66, started taking care of her mother in 2003, she had to learn how to bathe her, change her diaper and monitor her medicine. She said her mother going to the center three days a week is like “a child going to school.”

“I am able to know she is being taken care of for that period of time,” she said. “If it was not for that center, I do not know what I could do for her. . . . I would have to quit my job.”

Greenwood, 85, has diabetes that resulted in a leg amputation, a hand deformity that prevents her from feeding herself and a swallowing disorder that requires her meals to be pureed.

Sitting in a shiny blue wheelchair and wearing hoop earrings, she said she feels at home at the center, where she goes to art class, exercises and chats.

“I used to pray that the Lord would take me so I don’t be a burden on anybody,” she said in a Southern accent. “But he don’t listen. So here I am.”

Now Greenwood looks forward to art class. “It’s just fun to come and be with other people,” she said. “If this place closes, I would be home with me and the puppy because my daughter works.”

In the afternoon, a volunteer led the participants in spiritual songs. Some sang along. Others clapped. “Oh Lord!” one yelled out. Greenwood sat at her table, swaying gently.

I’ll fly away, oh glory, I’ll fly away. When I die, hallelujah, by and by, I’ll fly away.