Esther’s Story: Walking Again Thanks to Adult Day Services
Resource type: Grantee Story
“The first day I went to the centre, I was scared, I was in a wheelchair, and I was paralysed on the left side. Everybody was so friendly. My arm was frozen to my side, and now I can move it and I can open my left hand. They had to teach me how to dress again and walk again. They gave me my first walker. The social worker said, ‘How would you like to walk out of here?’ I said, ‘Don’t tease me.’ I walked out that night!”
— Esther Darling describes her experience at the Woodland Healthcare Yolo Adult Day Health Center in Woodland, California
Since that first day in 1997, Esther has been going to the Adult Day Health Center five days a week, the only thing that has kept her from ending up in a nursing home. She has diabetes, post-stroke paralysis, atrial fibrillation, incontinence, edema, depression, hearing loss, hemorrhoids and gout. Everyday, a nurse at the centre manages Esther’s 19 medications, monitors her blood sugar and water retention, and checks her for signs of heart failure. She also receives physical therapy.
In early 2011(and for the third time), California proposed cuts to adult day health services that affected up to 35,000 low-income seniors like Esther, as well as people with disabilities, putting them at risk of institutionalisation, social isolation, severe depression and death. These seniors are primarily women of colour who have little support outside of the centres in which they receive daily care, or they are living with family members who work during the day. The Atlantic Philanthropies has successfully supported and sustained the legal advocacy work on behalf of these crucial, proven health services.
“This model of out-of-home care has been in existence for 30 years,” explains Lydia Missaelides, executive director of the California Association for Adult Day Services. In California in 2011, the average annual cost of placing a patient in a nursing home was $77,745; adult day health services averaged $20,020.
Esther was a vocal advocate for retaining this vital programme, and even travelled to Sacramento to speak with legislators. She explains the motivation for her advocacy, including being the lead plaintiff in the case against the state:
“I was mad as a bee when I heard that the Governor planned to take this away! I wonder how he’d feel if he had to stay home seven days a week and had no one to talk to, and no one to share a meal with.
“They think just because we’re old we should sit on the porch all day and do nothing, and they could throw us away like an old pair of shoes!”
California would have been the first state to abandon this successful model of adult care. The National Senior Citizens Law Center (NSCLC), an Atlantic grantee, successfully deployed a strategic litigation and negotiation strategy to win preliminary injunctions against California’s proposed cuts, and then to reach a settlement with the state in November 2011. Because of the litigation and negotiation, Ms. Darling and thousands of other seniors will continue living in their own homes and benefit from daily care at the centres.
The National Senior Citizens Law Center continues working in several other states to protect and expand home- and community-based health services to keep low-income, frail elders out of long-term institutions, and to decrease health disparities impacting seniors of colour. Kevin Prindiville, deputy director of NSCLC, explains its work:
“The cases are ongoing, but we have victories along the way. We have a large number of national advocates and litigators with whom we communicate regularly, and we talk about using similar strategies. We know we’re succeeding when we’re on a call with our litigation work group, and we hear that an advocate was able to use what we did here in California to discourage similar attacks, and to get his or her state to go in the right direction.
“Our work is never detached from the broader goals of the advocacy movement on behalf of low-income older adults. That has always been a part of our model, and with the Atlantic funding, we are able to recognise advocacy opportunities to create systemic change.”
Atlantic grantees National Senior Citizens Law Center and National Health Law Program were among the organisations that worked on the strategic litigation and negotiation to win the settlement agreement that preserves adult health day centres in California.