Elimination of Adult Day Health Care (ADHC) in California: The Impact on Consumers and Their Families

In March 2012, the state of California eliminated Adult Day Health Care (AHDC), one of the most significant programs that allowed frail low-income older adults to live in the community by providing comprehensive care including medication monitoring, feeding, physical therapy, skilled nursing and individual supervision at a designated facility. Before its elimination, 37,000 older adults and their families in California depended on ADHC and over two-thirds (28,000) of these individuals currently live in Los Angeles County. With the elimination of ADHC, the state established two new programs for former ADHC beneficiaries---Community Based Adult Services (CBAS) and Targeted Case Management Services (TCMS). For older adults who have high levels of cognitive decline including Alzheimer’s disease, the transition to CBAS provided ADHC look-alike and there was no interruption of services. The remaining older adults were transitioned into TCMS where older adults and their families were connected to community based services such as In Home Supportive Services (IHSS) so they could continue to live independently. This study investigates how the state transitioned older adults from ADHC to TCMS and how this transition impacted frail low-income older adults and their families. Additionally, in-depth interviews with consumers and their families provides an opportunity to  better understand how older adults and their families construct and reinvent a matrix of care to maintain their independence in the wake of cutbacks to publically funded programs such as ADHC.