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Brantley v. Maxwell-Jolly

California's Attempt to Cut Adult Day Health Care Services is Blocked by Court

Among the people affected by the cuts is named plaintiff Lillie Brantley, an 84-year-old woman with Alzheimer's and a seizure disorder, who has had a stroke and is very frail. She needs supervision with feeding and transferring as well as assistance bathing, dressing and toileting, and is completely dependent on others for housework, laundry, shopping, medication, money management and meal preparation. Brantley currently receives professional nursing services to monitor her condition, personal care services to help with hygiene and feeding needs, and therapeutic services to increase her interactions with others and reduce her isolation as well as to help her maintain her functional strength. Brantley resides with relatives and is a member of her local community and church. She and her family want her to remain there, but her niece, who is her primary caretaker, must work full time and, consequently, Brantley is only able to remain in the family home with the assistance of ADHC services. Her only alternative, if ADHC services were cut back, would be institutionalization — to her detriment (studies document rapid deterioration when frail older people are moved to unfamiliar environments), against her wishes and the wishes of her caretaker family, and at significantly higher costs for the State of California.
Gilda Garcia, another plaintiff, is 77 years old with unstable diabetes, hypertension, Bells' palsy and kidney problems. She uses a cane and needs help with transferring, bathing, meal preparation, shopping, transportation, housework and laundry. However, she enjoys living in her home and in her community, enjoys her interactions and social activities, and wants to remain there. ADHC services provide her personal care services, professional nursing services, leisure opportunities, physical therapy and dietician services five days a week. Without ADHC, it is inevitable that she would have to be in an institutional setting because of her unstable diabetes.
In addition to challenging the actions that would be taken if the law is allowed to take effect, plaintiffs challenge the notice that was sent by the state about the changes, arguing that it violates their statutory rights under Medi-Cal. Plaintiffs asked the federal court to prevent the law from taking effect while this lawsuit is pending, and ultimately, to rule that the California budget cuts violate Medicaid law and the ADA.

The Court's Ruling

Ruling that ADHC recipients were at serious risk of institutionalization and "particularly irreparable and imminent" harm, the court issued a preliminary injunction that prevents the cuts from taking place while the lawsuit is pending.

The court went to say that the state has "taken an arguably cavalier approach to ensuring their continuing compliance with the ADA and Rehabilitation Act" and had done no more than show a "theoretical" availability of alternative services. These minimal showings, the court ruled, were insufficient to guarantee the safety of ADHC recipients. "Given the tenuousness and complexities of their conditions, an interruption in their care, even if temporary, will have serious consequences for Plaintiffs," the court ruled.

A separate lawsuit, in which AARP Foundation Litigation attorneys have filed AARP's "friend of the court" brief on behalf of health care providers, challenges other elements of the state's budget cuts regarding reimbursement of health care service providers, and is proceeding through the courts as well.

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