Community-Based Long-Term Care: Potential Consequences of California’s 2009 Budget Cuts

Source: Steven P. Wallace, Valentine M. Villa, Lauren Smith, Delight E. Satter, Nadereh Pourat, D. Imelda Padilla-Frausto, Rosana Leos, Eva Durazo, A.E. (Ted) Benjamin, UCLA Center for Health Policy Research, October 2009

California was once a leader in innovating new ways to provide long-term care services that allow older adults and the disabled to remain safely in their homes as long as possible. In the early 1970s, for example, a San Francisco organization called On Lok innovated a comprehensive program that created an adult day health center and supportive in home services to allow seniors to remain out of nursing homes. By 1990 this model, now called the Program of All-inclusive Care for the Elderly (PACE), had been successfully replicated elsewhere and became a Medicare/Medicaid waiver program that is now available nationally ( The state was also a laboratory for the development of the Social HMO, consumer directed home care services, and caregiver support services.

Hundreds of thousands of seniors are likely to lose some or all of the assistance they rely on to remain at home. Available program data suggest that budget cuts are not necessarily targeting the least disabled. Studies from other states document that such cuts increase emergency room, hospital and nursing home use. Experts from a range of organizations dealing with the elderly in California who served as key informants for this research concur that these are likely outcomes from California’s budget cuts, along with increased stress on family caregivers (for those fortunate enough to have a family caregiver) and reduced jobs and benefits for paid caregivers. This report begins with a summary of the cuts and provides detailed discussions of how those cuts will impact the major programs and populations affected. It offers a summary of our key informant interviews on this topic as well as a summary of the published literature on the effectiveness of these types of programs. We end with a call for California to return to its past innovative spirit of designing new ways to help disabled older adults remain safely at home.
See also:
Policy Brief

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