Mariv Tesoro is trying to stay positive. Working as a registered nurse and program director for an Adult Day Health Care Center in Downey, where families bring their elderly relatives for health care and social activities during the workday, Tesoro works to help her patients as they face their inevitable mortality. Working with the sick and the dying, positive thoughts can be hard to come by.

“It’s very fulfilling…you just have to try and hope you don’t go down with them, emotionally,” said Tesoro.

This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.

But while people like Tesoro are able to control their attitudes and emotions, they have less control over the daunting fate of their industry at large. California’s budget chasm has already forced legislators to cut the Adult Day Health Care program’s entire working budget and now even a last ditch effort to reinstate a new ADHC program looks as though it may get the cut as it sits on Governor Jerry Brown’s desk unsigned.

Back in March, legislators approved a bill to re-build a new ADHC program under a federal program that would bring in Medicare dollars and allow the State more flexibility in designing the program. The new program would function at half the cost of the existing ADHC program and would take over once the existing service is de-funded.

“It is critical that our patients have the proper services,” said Marie Torres, Senior Vice President of AltaMed Health Services Corporation in Los Angeles. Torres’ adult day care center has been around since 1982.

The bill to restructure the adult day health program is now included as part of the larger budget package. Adult day care advocates fear the governor may veto their bill.

“Certainly, the reason I think we have the fear is because in all of his budgets, we’re always on the chopping block,” said Mallory Vega, Executive Director of Acacia Adult Day Services in Garden Grove. Vega’s center has been around since the inception of the ADHC program in California in the late 1970’s.

Earlier this year, Governor Brown’s proposed budget allocated $25 million to phase out the program. But the bill calling for a new ADHC program asks for $85 million, exactly half the cost of the existing ADHC program.

Until Governor Brown makes a decision to either veto or sign the bill, ADHC centers are in financial limbo, unsure as to whether their doors will be open next year.

“It’s heartbreaking,” said Vega. “Back then, we were lucky to open (the Acacia center) in California because California was the cutting edge in providing these services.”

The new ADHC program, called KAFI, Keeping Adults Free from Institutions, would be a dramatic downsizing from the State’s current adult day care system. Hundreds of adult day centers could still close under the financial stress of having their budgets cut in half. For the centers that would stay open, medical services would likely be scant for elderly patients.

Advocates anticipate the KAFI program to be very small, but little is known of the details of the program beyond its decrease in size. Nobody will know exactly what services will be cut or which centers will be forced to close unless Governor Brown were to permit the State to negotiate a waiver program with federal Medicare officials. But advocates are still depending on the new program as a way to keep day care services available to at least the patients who need it most.

“These are people who are on heavy duty medication and who need assistance going to the bathroom and eating their meals,” said Vega. “Their families aren’t in a position to be losing their jobs (to take care of them.)”

Vega said 70% of her patients rely on Medi-Cal to pay for their services. Without funding from the State, Vega would have to turn away Medi-Cal recipients.

Those who would be turned away would then have two options, Vega said: 1) Be left at home during the day while their family members are at work or 2) Find a nursing home that accepts Medi-Cal.

“That is very difficult because the nursing homes for the most part aren’t going to have enough beds for everyone,” said Vega.

The tension in the state’s Capitol is equally palpable. Legislators fought to keep the ADHC program intact but, faced with a daunting budget gap, ultimately accepted the program’s closure as inevitable and chose instead to pursue the possibility of creating the KAFI program with the help of a federal waiver, which would bring in additional federal funds for the program and allow the State more flexibility in deciding what services to provide and who is eligible to receive care. But since Governor Brown’s decision to veto the budget at large, officials are skeptical about whether he will approve the KAFI program.

In the meantime, “you have to live it day-to-day,” Tesoro said.