The Marin Adult Day Health Center in Novato — the county’s only such site — is shutting down, leaving 36 clients with no alternative program.
Jacquie Phelan of Fairfax said she received the news recently after trying to arrange for her husband Charlie Cunningham, 74, to get care there. He suffered a traumatic brain injury in a bike accident in 2018.
Phelan, 67, and her husband visited the center in October and filled out paperwork. But they heard nothing back from LifeLong Medical Care, a federally qualified health center in Berkeley, which took over the center in 2008.
“I would routinely call every couple of weeks to ask if there were any hurdles,” Phelan said. “I didn’t get any feedback.”
In the meantime, she placed her husband at a long-term care center in San Anselmo.
“He’s always happy to see me and hoping to come home, which I don’t think is realistic because I can’t do that kind of care,” Phelan said. “It’s been a long, hard eight years. I burned out.”
Adult day services provide an alternative to nursing home care for people who do not need 24-hour skilled nursing. They give caregivers, often family members, some time to rest or do other tasks while allowing their loved ones to remain at home. The Marin Adult Day Health Center picks up participants in the morning and then transports them home in the mid-afternoon.
Kari Beuerman, an assistant director with the Marin County Health and Human Services Department, said LifeLong did not notify the county of its plans to close the center.
Sylvia Hacaj, the company’s director of development and communications, disagreed.
“We informed the county shortly after we talked to our staff and participants,” she said. “I would not think it would have come as a surprise, as we did reach out to them a year ago to let them know we were struggling to continue supporting this site. Unfortunately, they had no funds available to assist.”
David Vliet, LifeLong’s chief executive officer, said the board of directors made the decision to close the center on Feb. 28. Clients and their families were notified of the closure plans on March 21.
An email LifeLong sent to “community partners, neighbors and friends” stated, “This heartbreaking decision was made because financial sustainability of the center is no longer viable for LifeLong. This comes after years of rising costs and loss of funding that historically supported the Center.”
“We did carry the center for as long as we possibly could,” Vliet said. “This was not a decision that was made lightly.”
Beuerman said that for six years, from fiscal year 2011-12 to 2017-18, Marin County transferred $125,000 annually that it received from Partnership HealthPlan of California to LifeLong to help support operation of the center. Partnership HealthPlan of California, based in Fairfield, manages the health care of Marin residents who qualify for Medi-Cal.
Johnathan Logan, a Marin Community Foundation vice president, said the foundation provided the center with grants from 2012 through 2018. Logan said the support amounted to about $40,000 a year from 2015 to 2018. He declined to say what level of support the foundation was providing prior to that.
As to why the foundation stopped funding the center in 2018, Logan said, “The foundation periodically makes changes to its strategic plan and direction. Different initiatives have different life cycles and so for this particular initiative the cycle ended.”
LifeLong, which was founded by the Gray Panthers in 1976 as a health center for people over 60, operates 14 primary care health centers, four dental centers, four school-based health centers, a supportive housing program, mental health services and urgent care centers.
LifeLong’s 2022 annual report stated that it expects to open a new health center in Berkeley this spring and to break ground on a new health center in East Oakland sometime this year. According to the annual report, LifeLong had over $122 million in revenue in 2021, including nearly $45 million in grants, and ended the year with revenue exceeding expenses by $4 million.
But Vliet said LifeLong’s financial health is not as rosy as that report might indicate.
“COVID had an impact on us,” Vliet said. “Costs have risen. Volumes have not been what they have traditionally been in the past. We’re currently running a significant structural deficit.”
LifeLong served 56,612 patients in 2022, an overwhelming majority of whom were low-income people of color. Before the COVID-19 pandemic began, Lifelong served 66,681 patients.
Vliet added that LifeLong’s labor costs have increased substantially. He said most patients receive Medi-Cal and government reimbursements are insufficient. The East Oakland health center project has been put on hold.
Vliet said the Marin Adult Day Health Center has been operating at a substantial deficit for a number of years. Losses over the last five years have totaled more than $2 million, and a loss of $600,000 is projected for next year.
“ADHC is an expensive program to operate,” Vliet wrote in an email. “Medi-Cal reimbursement doesn’t cover costs; we are a small center, so don’t have economies of scale; enrollment dropped precipitously during the pandemic; and we have not been as successful in securing grants as in the past.”
Debbie Toth, the chief executive officer of Choice in Aging, a nonprofit that operates adult day health centers in Pleasanton and Antioch, said Marin’s center is one of many around the state that are closing.
“The infrastructure in our industry is crumbling because we do not have funding that meets the regulatory requirements of service delivery,” Toth said. “That is the bottom line.”
Toth said state staffing requirements for adult day health centers mirror those for skilled nursing sites.
“We have to have the same medical director, pharmacy consult, psyche consult, nurses, social workers, physical occupational speech therapy, registered dietician, and then we have activity coordinators, professional activity staff, and professional care providers,” Toth said.
Vliet said the Marin center has 20 employees.
Most patients at adult day care health centers qualify for Medi-Cal. But Toth said Medi-Cal managed care plans, such as Partnership HealthPlan of California, can basically dictate the rates they pay for providing adult day care since it is considered an optional benefit and there is no legislated minimum payment.
Vliet said Partnership HealthPlan has approved a Medi-Cal reimbursement rate of $100 per day for clients at the Marin center while the current cost is $345 per day. He said the Veterans Administration, which is supposed to be paying for three participants in the Marin program, has paid for only one day of care since 2020.
Dustin Lyda, a spokesman for Partnership HealthPlan, said it is “saddened by the closure of LifeLong Marin Adult Day Health Center.
“Partnership will not speculate on the specific factors leading to the decision made by MADHC,” Lyda said.
Toth said, “We prioritize institutional care over community-based care in our policies and our funding. It’s a broken system.”
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