1999 US Supreme Court Olmstead Decision
* Sacramento Bee Article Focuses on California Commitment
* Need Stressed for More Community-based Alternatives
* Article Cites Little Hoover Report That IHSS Program Not Enough

SACRAMENTO  - The 1999 US Supreme Court Olmstead decision, that required the states to take steps to avoid the "unnecessary institutionalization" of people with disabilities and seniors, was the focus of a Sacramento Bee article, published Saturday, November 27, that raised questions on California's commitment in complying with the landmark ruling.

The Sacramento Bee article cited a federal investigation of Laguna Honda, a major state and local government operated skilled nursing facility in San Francisco, that found the State, in failing to conduct appropriate assessments of people with disabilities and seniors residing there, led to "unnecessary institutionalization" of many of those individuals.  The article reported that the California Department of Health Services, the agency that oversees the state's Medicaid program (known as "Medi-Cal") declined to respond directly to the findings - but did indicate that it was still reviewing it.

Those advocates referenced in the article said there was a need for more community-based alternatives to nursing and other skilled health facilities and a need for more funding from Medi-Cal.  The Department of Health Services claimed it was responding with several pilot community-based programs.

Previously, the Schwarzenegger Administration has cited its efforts to involve hundreds of people in the process to "redesign" or overhaul the state's Medi-Cal program and its success in recently securing last August hundreds of millions of dollars of new federal matching funds for a part of the In-Home Supportive Services that was originally slated last year for elimination, as evidence that it was serious about compliance with the US Supreme ruling.  Many advocates however remain critical and contend the Administration's real intent is to cut costs of the Medi-Cal program that will result in significant harm to the rights of children and adults with disabilities and seniors - a claim that Adminstration officials dispute. Some advocates have been also critical of the previous Davis Administration out that it took nearly four years for the State to develop a plan for compliance and to establish an initial Olmstead advisory group - which never met.

Next Steps Planned
DEC 2 DISABILITY/SENIOR RIGHTS TOWNHALL TELEMEETING
* The next regularly scheduled Disability/Senior Rights Townhall Telemeeting, organized by the California Disability Community Action Network, is set for December 2, Thursday afternoon at 1:00 PM to 2:45 PM.  It will focus on any updates on Medi-Cal Redesign, and any other proposed changes, and will feature Stan Rosenstein, deputy director of the Department of Health Services Medical Services Division, which oversees the Medi-Cal program.
* Also featured on a different subject will be Connie Garner, senior staff from Sen. Edward M. Kennedy's Washington office, who worked on the reauthorization of the federal Individuals with Disabilities Education Act (IDEA) that passed Congress earlier this month.  To participate in this townhall telemeeting, please visit the CDCAN website at www.cdcan.us and click under "Townhall Telemeetings" or call Sheri Van Wert, at TTSR (Training Toward Self Reliance) 916-442-8877 extension 100 to sign up.  The December 2nd Townhall Telemeeting is being sponsored by Easter Seals of Southern California.
COMMUNITY HEARINGS
* The California Disability Community Action Network is working to organize, with other community groups and individuals, a series of non-partisan community hearings across California beginning in January 2005 to hear how people with disabilities, seniors, their families, community-based organizations, direct care workers, and others are faring under recent legislative, regulatory and budget changes impacting day and adult programs, housing and other residential facilities, accessible transportation, special education, supported employment, work activity programs, In-Home Supportive Services, Medi-Cal and access to other health care, SSI/SSP, impact of workers compensation and other costs, etc.  Also to be discussed is a proposed amendment to the state constitution protecting the rights of children and adults with disabilities and seniors.
* The Community Hearings will also focus on how the State is complying under the various state and federal laws that protect the rights of people with disabilities and seniors, including the federal Americans With Disabilities Act (ADA) and the subsequent Olmstead Decision; the California Lanterman Developmental Disabilities Services Act, the federal Individuals with Disabilities Education Act (IDEA), the federal Rehabilitation Act.
* The Community Hearings will serve as a vehicle to help mobilize people locally and provide information to help in a unified advocacy effort on disability and senior issues that impact a community.
* For more information, see the CDCAN website at www.cdcan.us or call 916/442-8877 ext 100 or write email to martyomoto@rcip.com

REPRINT OF ARTICLE IN SACRAMENTO BEE
[Note: this is a complete reprint of the article in the Sacramento Bee that appeared on November 27, Saturday, including headlines. The article had to be retyped because an online version was, for some reason, not available at the time of this report.  In reprinting this article, CDCAN is not confirming the accuracy of the article itself, but is passing this on because it should be of interest to people with disabilities and seniors across the State - CDCAN Capitol News Report]

"If you go on Medi-Cal, you're going to have to go into a nursing home - whether that's the level of care you need or not."
Ruth Gay
director of public policy with the Alzheimer's Association in Northern California

Nursing homes as default
U.S. chides state on community care access

By Nancy Weaver Teichert
Bee Staff Writer

    Five years after the U.S. Supreme Court ruled that the elderly and disabled should be able to live in the least restrictive
settings, California has yet to act, leaving them in nursing homes, federal officials say.
    Advocates backed up by a federal investigation accused the state of a "one size fits all" philosophy on indigent patients who need long-term care: sticking them in a nursing home.
    That means many elderly and disabled people are robbed of a better, more independent life with community-based
services, advocates say.  The U.S. Justice Department said the unnecessary institutionalization amounts to discrimination.
    Taxpayers have a stake because the nursing-home route is the most expensive option in many cases, according to cost estimates.
    The entire system is flawed, said Cynda Rennie, a Sacramento elder care consultant.
    The ongoing Justice investigation concluded in August that the state has failed to ensure nursing home patient    access to community-care alternatives.
    Community care can include adult day health care, personal assistance in the home, assisted living or residential care facilities for the elderly.
    R. Alexander Acosta, assistant attorney general for civil rights, chided state officials that the court's landmark ruling in the Olmstead case "made clear that unnecessary isolation of individuals with disabilities in institutions, including nursing homes, is discrimination."
    Stan Rosenstein, deputy director of medical care services for the state Department of Health Services, declined comment on the federal charges, saying his staff is assessing the findings.
    But he said the state has created several small but "cutting-edge alternatives" to nursing homes that have helped to keep their patient numbers from growing over the past decade.
    The federal probe of a 1,200-bed nursing home in San Francisco found that the state routinely authorized placements without assessments to see if home or community-based care would be appropriate.
    The Little Hoover Commission has estimated that one-third of those in nursing homes could be cared for in their communities with local services.  Rennie believes it's closer to 50%.
    "There are people who are in nursing facilities who can be treated at home and should be moved," said Rosenstein. "I think that number has declined."
    "If you go on Medi-Cal;, you're going to have to go into a nursing home - whether that's the level of care you need or not," said Ruth Gay, director of public policy with the Alzheimer's Association in Northern California.
    California has prided itself on the In-Home Supportive Services program (IHSS), which provides personal care assistance to 300,000 more independent low-income seniors and disabled in their own homes.
    The problem is the state doesn't offer enough between this and nursing home care, federal officials and others say.
    A study by the California HealthCare Foundation found that IHSS is not enough help for many.
    California pays an average of $3,600 a month for 65,000 patients on Medi-Cal in nursing homes.  The MetLife Market Survey found recently that the average cost of assisted living nationally is $2,524.  Some board and care homes charge
$1,500 a month.
    Rosenstein argued that community care can be equally expensive given the medical needs of some patients. "They don't actually end up saving money," he said.  However, he agreed that "it's a far better way to provide care."
    Jack Christy, director of public policy for the California Association of Homes and Services for the Aging, said the state  is taking only baby steps toward these alternatives.
    "They're doing the minimum possible to live up to the law," he said of state officials.
    After the 1999 Supreme Court decision, the state Legislature asked the California Long Term Care Council to come up with a plan to implement it.  Since May 2003, that 61-page plan has sat on a shelf.
    In September, Gov. Arnold Schwarzenegger vetoed SB 1365, which would have appointed a new Olmstead Advisory Council.
    He then ordered state health officials to set up a new Olmstead Advisory Committee, while promising to act to stop unnecessary institutionalization.
    Meanwhile, state health officials are preparing their first small pilot programs to experiment with using Medi-Cal to pay for assisted living and relocating some patients out of nursing homes.
    Jason Bloome with Connections, a senior referral service in Southern California, said even those pilots are being badly "bungled" as inefficient and costly, undermining the goal of de-institutionalization.
    Senior advocates say families provide care at home themselves or come up with the money to privately pay for community care.
    It costs $4,020 a month for Constance Hagen to keep her husband, Erwin, who has Alzheimer's disease, in a home-like residential care facility.
    Without his long-term care insurance, the retired teachers could not afford it and he'd be in a nursing home on Medi-Cal.
    Rennie has found a 12-bed residential care home for Hagen after his wife of 54 years lost 40 pounds and nearly grew ill herself providing full-time care at home.
    Erwin "Sonny" Hagen doesn't need a nurse or other medical staff.  He just needs someone to spend an hour or more to feed him his meals, lift his arms and legs, tend to his incontinence, shave and shower him, and lift him into his wheelchair.
"He's a hundred time more comfortable here than he would be in a nursing home," said Rennie.
    From his favorite recliner, Hagen watched the "Dick Van Dyke" show on television in the family room of the 12-bed Nelu's Home Care.  The rooms are arranged as they would be in a home, but there is a staff of six, one awake all night.
    Hagen and his roommate sometimes talk about going out to take his sailboat for a spin.  Sometimes, he talks to the care home staff as if they were his students.
    When asked if he likes his home, Hagen slowly said "Nice to be here."

[Note from CDCAN Capitol News Report: there was a chart and two large color photos (page 3) of Constance and Erwin Hagen and one black and white photo of Erwin Hagen on page 4.   Information on the chart was:]
Living Longer  [chart]
As life expectancies increase with advances in health care, the size of the state's oldest senior population is swelling.  Experts fear the trend means more frail seniors who will need more care.

Californians age 85 and over
2000        449,762
2010        638,000 [projected]
2020        728,000 [projected]
2030     1,033,000 [projected]

Source: California Department of Finance  Sacramento Bee

FOR MORE INFORMATION ABOUT CA DISABILITY COMMUNITY ACTION NETWORK
URGENT - CONTRIBUTIONS NEEDED TO CONTINUE EFFORT
Many many, thanks again,  to the friends, people with disabilities and their families, community organizations and others who have sent in generous and needed contributions and donations.  Contributions from people and organizations is  very urgently needed to keep the advocacy efforts going for the next several months, as we work to establish non-profit status which we are working on.. Apologies to anyone who have not yet received a thank you - email, letters, calls have been overwhelming!  Your help is needed though to keep the effort going!
Please make check or money order  to:  California Disability Community Action Network  (or abbreviate CDCAN).  A method to contribute by credit card (through Paypal) is NOW set up on our website, at www.cdcan.us [new site address]  Send contributions to: California Disability Community Action Network,  1225 8th Street Suite #480, Sacramento, CA  95814.
* Who Is CDCAN?
The California Disability Community Action Network is a non-partisan link to thousands of Californians with developmental and other disabilities, people with traumatic brain and other injures, seniors and their families, community organizations and providers, direct care and other workers, and other advocates.
These action alerts and news reports is for all of them. In addition it also goes to news organizations, state and local government officials and staff.
* How To Receive CDCAN Capitol News Reports and Alerts
If you would like to get on this distribution (and conversely, get off of it) please send an email with that  request to:  martyomoto@rcip.com OR sign up via the
NEW CDCAN website at www.cdcan.us  Sharing information is part of our organizing effort. Please feel free to forward or copy  this (attribution is nice). We're all in this together!
* How To Contact CDCAN
Marty Omoto, director/organizer  WEBSITE:  www.cdcan.us [new address]
1225 8th Street Suite 480 Sacramento, CA 95814   VOICE PHONE: 916/446-0013
FAX number: 916/446-0026        email: martyomoto@rcip.com