County buys $1 million of respite for overworked caregivers

March 18-- Mar. 18--It costs $95 a day to hang out at Glenner Town Square, the 1950s-themed adult day center in Chula Vista where people in the early stages of memory loss are transported daily to a time when many of their most lasting memories were made.

But an unprecedented local program will cut that price in half for those selected to participate in a pilot project that allocates $1 million to buy a little respite for caregivers struggling to keep up with the daily grind involved in taking care of loved ones with Alzheimer's disease and other forms of dementia.

Championed by county Supervisor Dianne Jacob, the Respite Voucher Program is aimed at those families in the middle for whom the cost of an occasional breather always seems to take a back seat to the necessities that only multiply when caring for a person with a condition that often lasts for years.

"People of high income can afford respite care and in-home supportive services does cover some of this kind of help for people of lower income," Jacob said. "This program is geared toward the middle class, those caregivers who are hard-pressed to have the resources to hire a person to relieve them, even for a few hours a day."

The program splits grant money among two local contractors who have each committed to offering three different types of respite care at roughly half the price it would normally cost.

"Our idea was to leverage county money but not to pay the whole bill," Jacob said. "We wanted the recipient to have some skin in the game, and we know that the county cannot do it all on its own."

While Medi-Cal, the state's health insurance program for needy residents, has funded in-home supportive services for many years, it's the first time that local government has gotten involved with paying for respite care.

The county's decision to fund the project, said Susan DeMarois, California government affairs director for the Alzheimer's Association, is more than innovative.

"This is unprecedented in California to have local government initiate something like this," DeMarois said. "The only other program I'm aware of is in New York state where Gov. Cuomo allocated $67 million for a caregiver initiative that includes some grant funds for respite care."

She added that Jacob's assertion about many being caught in the middle is not just an opinion. It's supported by solid data.

"About 20 percent of people will qualify for Medicaid and other public programs, and about 20 percent of people are able to self-fund their care," Demarios said. "That leaves about 60 percent of people, just as a general rule, who are paying out of pocket."

Given that 84,000 San Diego County residents are estimated to be living with Alzheimer's or a related form of dementia today, that means potentially 50,000 people across the region could use this kind of help.

There is no way that a $1 million allocation from the supervisors, even it it is only paying half of the total cost of respite care, will make much of a dent in the problem. But Jacob said this is just a start. If the project goes well and measurably improves the lives of caregivers and people living with memory loss, she said, more funding could be discussed.

"The goal would be to increase this program into the future and maybe even encourage other opportunities," Jacob said. "We have a lot of foundations in San Diego County and I think, if we can show effective results, I don't see why this couldn't be a model not just for county government, but also for other organizations."

Approved with the supervisors' recent budget, the program launched this week with Southern Caregiver Resource Center and Coast Care Partners, the two contractors that will each receive $500,000 to offer respite-care vouchers.

Directors of both organisations said they will offer three different types of respite care: In-home, adult daycare and short-stays at local assisted living centers.

Experience has shown, said Robert Velasquez, executive director of Southern Caregiver Resource Center, that the bulk of demand will be in the home.

"Based on our experience over the last 30 years, we know that most of the families are looking for in-home care, so we expect that that's where 70 percent to 75 percent of the funds will end up getting spent," Velasquez said.

However, there is a growing demand, added David Chong, founder and chief executive officer of Coast Care Partners, for opportunities like those available at the 20,000-square-foot Town Square project, which has gained international attention for its immersive, 1950s-style streetscape built inside a Chula Vista warehouse. Others may themselves need significant medical attention that requires someone else to supervise their loved one overnight.

"It was important to have several different options that caregivers can choose from, because we know from experience that not every situation is the same," Chong said.

West has set up a website -- www.coastcarepartners.com/respite-well -- that details the costs of its three-tier program. The cheapest level, in which the recipient pays $234 per month, affords four hours of home care, one day of adult daycare per week and one week of assisted living every four months. For $468 per month, eight hours of home care are provided with two days of adult daycare per week and one week of assisted living every two months. A "crisis" program provides three days of home care and eight days of assisted living for a one-time fee of $988.

Initially, Chong said, the company is working with a handful of hospitals, skilled nursing facilities and hospice operators to provide vouchers to people that those organizations recommend. But the program plans to move to a lottery system to decide who receives the bulk of the vouchers in the future.

Velasquez said his company's program is still being designed but will offer the same three levels of care.

"Right now we're still in the implementation phase where we're putting together contracts with respite providers. Our goal is to be able to offer it in the beginning of April," Velasquez said.

Both programs plan to include use of the Glenner facility in Chula Vista, which capitalizes on research that shows many with memory loss retain early memories from childhood and early adulthood even if their conditions have significantly eroded their ability to make new memories. Designing a facility around what those early memories actually looked like can make a location feel more comfortable and, organizers hope, reduce the chances of wandering, agitation and even violence.

Kimberly King, a former local television personality turned media consultant, said she has been bringing her mother, Jackie Taylor, to the center about three times per week since it opened last August.

The opportunity to get a breather and be able to focus on the needs of the rest of her family, she said, is something that can benefit anyone coping day-to-day with caring for a person with memory loss.

At first, she said, her mother, now 77, wanted to leave. But she has gradually been pulled in by all of the activities that the center offers and the environment they're offered in.

"Lately, she wants to come back on the weekends when they're closed," King said.

Skeptics might wonder what the county gets for its $1 million investment beyond the basic satisfaction of helping people who are often forced to subordinate their own needs to take care of a loved one 24 hours a day, seven days a week.

DeMarois said there have been several studies show that respite care can help decrease stress and increase opportunities to take care of their own health needs whether that's making it to a doctor appointment that their responsibilities have forced them to keep cancelling or socialize with friends they've been missing.

"This year, we're going to spend about $4 billion on this population from Medi-Cal alone, and we will have more than 900,000 emergency department visits statewide associated with this population," DeMarois said.

"The research finds that people don't need a lot of respite hours, but when they get them, the chances that they're going to call 911 when they just get overwhelmed go down, and the chances that they're going to be able to keep caring for their loved one in their home, rather than putting them in very expensive residential care, goes up."

paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson

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