County ready to hand over adult day care

The two people set to take over Tuolumne County’s Adult Day Health Care, designed to give elderly and disabled adults a place to stay while their caretakers are away, are intimately acquainted with the challenges senior citizens face.

During his 13 years as an emergency room physician in Tuolumne County, Dr. Bob Uslander has seen a number of elderly patients whose health has deteriorated unnecessarily due to neglect, while Katherin Johnston once headed the county’s Adult Day Health Care in the late 1990s, when its client load was nearly double what it is now.   

Though the two are hoping to turn a profit by running the program, staring in February, they say they are driven by their desire to help the elderly, many of whom, they say, often don’t get the help they need.

The county-run Adult Day Health Care program is located on the Tuolumne General Medical Facility campus in Sonora. The county moved earlier this month to gradually transition the program to a private provider.

The Tuolumne County Board of Supervisors could finalize the privatization agreement with Uslander and Johnston, who have teamed up to form Seniority LifeCare at Home, sometime in January. The two currently run Sierra HouseCalls, which provides doctor’s visits and various services to elderly clients within their homes. They plan to keep that service operational even after they take over the Adult Day Health Care.

Like the Adult Day Health Care, the goal of that program is to keep elderly adults in their homes and out of costly acute care settings. Without the care the programs provide, Uslander and Johnston said it’s possible some of the clients could lose their independence, and thus have to move to a nursing home.

Though some elderly Adult Day Health Care residents recently expressed some concern about what the future of the program holds, they said if the transition of the service runs smoothly and the program becomes even better, they would support the move.

Several family members of the program’s clients spoke up at a Board of Supervisors meeting earlier this month, and they all strongly supported the move. None spoke against it.

Uslander said in a recent interview the transition of the Adult Day Health Care to private hands will be “seamless,” with most of the program’s existing staff — from therapists to nurses — remaining at the facility.

“Most of them, I’ve either worked with or hired,” Johnston said. “I think they have a lot to offer to the program.”

The county is providing some financial help to ensure a smooth hand-over. Under the transition model, Uslander and Johnston will fully take over the program in fiscal year 2010-11 at no cost to the county, while the county will subsidize the program to the tune of $68,000 for the remainder of this fiscal year, and $217,000 in fiscal year 2009-10.

The move to a private provider, like the closure of Tuolumne General Hospital in 2007, comes due to fiscal constraints. The program annually runs in the red, despite having a regular daily client load.

Johnston and Uslander think they can change the fiscal outlook, especially considering the program is covered by Medi-Cal.

Johnston said governments are generally unable to pull in a profit when providing medical-related services because they have so may overhead costs that have “nothing to do with day-to-day operations,” whereas private providers are able to focus on the business at hand.

“We have our specific little corner,” she said.

The two also hope to bring in more clients to increase profitability.

More money could equal a higher level of staffing and,therefore, better service, Johnston said.

Johnston noted that, although the senior population is growing in Tuolumne County, the average daily client load at the facility has decreased from around 40 in the late 1990s to just over 20 today. Its daily capacity is estimated at 50.

Johnson said the recruiting problem might be due to misconception — that many seniors may think it’s for people who need around-the-clock care. That’s not the case, she said.

Indeed, the clientele at the facility varies, with some attending because they need regular supervision while others go just to seek conversation with friends.

Even something as minor as human interaction is important for seniors, according to Uslander.

“There can be a loss of a will to live, which has an impact on health,” Uslander said. “Seniors can become isolated and they can develop depression.

“But,” he added, “if they have a reason to get up and and get dressed, their lives become a little bit richer.”

The friendships the seniors develop at the facility provide that richness, according to Uslander. 

And “it’s only going to get better,” he said, as his company grows.