Every weekday at Altamedix adult day health care center in North Sacramento, over a hundred Russian-speaking immigrants follow a tight schedule of health education and exercise.
"It's very structured here," says Mikhail Borisov, a social worker at Altamedix. He says the people here get this state-funded service because their health is at risk. Almost all of them are elderly.
"They need at least supervision with things like bathing, dressing, they aren't able to access resources by themselves without assistance," explains Borisov.
Some of the eastern Europeans here came as refugees after the fall of the Soviet Union. Their medication is managed and their therapy individualized, but Borisov says that's not all they get.
"For many of them, this is everything. This is the only contact with the outside world that they get," says Borisov.
DETERMINING WHO'S INELIGIBLE FOR ADULT DAY HEALTH
When a legal settlement restored adult day health in the state budget last year, the new program was reserved only for the frailest. In recent months, state-employed nurses have been visiting the centers to determine which participants are needy enough to keep getting the service.
"It is difficult, but it's better than the worst-case scenario," says Sergey Ionov, Altamedix's director. He says twenty-eight participants have been deemed ineligible for service. They appealed and hope to win back the right to stay. The center isn't being paid while they wait for the appeal hearings.
"A lot of these people have attended our program for years and they need the services. They have little or no alternatives," elaborates Ionov.
The state is also backlogged on paperwork that allows Altamedix to be paid for other participants. Ionov says more than 40% of the cases here are currently unbillable, and he keeps the doors open with a line of credit.
"The main thing is that our participants continue receiving services, that's the main thing," says Ionov.
CENTERS STRUGGLE WITH 'CASHFLOW' PROBLEMS
At over 260 centers like this around the state, the cashflow situation is what Lydia Missaelides would call "dire." She's with the California Association of Adult Day Services or CAADS.
"Some centers have already reduced hours of operation, some have already reduced their staff, laid off some staff. Some are preparing plans for temporarily closing. Others are having a very difficult time finding lines of credit," says Missaelides.
CAADS surveyed its centers. Those that responded said if the state reimbursements don't start coming in soon, they would have to close, lay off staff, or stop serving the participants who have been judged ineligible.
"It's the worst I've seen in all of my years of working in this field, and I...I am trying to stay optimistic," explains Missaelideas.
ADULT DAY HEALTH PROGRAM TRANSITION 'A LONG, HARD
The California Department of Health Care Services says about 1800 people have been found ineligible and have asked for an appeal, and about 200 nurses are working on the entire transition. John Shen is the department's director of Long Term Care.
"So we're behind and we try to catch up, just because of the volume of the work that we have to deal with," says Shen.
Shen says they're hoping the hearings go more quickly when they've ironed out the system.
"This has been a long, hard process for the Department as well as for the provider as well as for the consumer, not knowing what happened to them, and, but we are really at the end of it so to speak, at the end of the tunnel," elaborates Shen.
But for many participants, hearings could be months away, and for the centers, the transition is far from over.
Meantime, Altamedix continues to serve the 28 ineligibles without reimbursement.
The old and fragile adults are known to break out in traditional church songs during monotonous exercise.
They may not fully understand the complexity of the situation, but they fear they may not be coming here for much longer.