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Medi-Cal recipient, 101, evicted from Santa Rosa assisted living facility for being unable to pay.

Mabel Barnfield, like most people, probably never thought she’d live to be 101, and she clearly did not expect to be paying nearly $7,000 a month to be living in a senior residential care facility.

The expense drained her of all the money she had after selling her modest home in Santa Rosa’s Holland Heights neighborhood in 2013. By November of last year, all Barnfield could afford to give Brookdale Fountaingrove, the assisted living facility, was her monthly Social Security check of about $1,300 — it wasn’t enough.

“How do you plan for that? It’s an awful lot of money every month,” said Barnfield’s younger sister, Betty James, 90, of Santa Rosa.

On April 18, Barnfield, who suffers from dementia, was wheeled into Sonoma County eviction court on Cleveland Avenue. With her bank account drained, the former real estate agent was now receiving Medi-Cal, the state’s version of Medicaid health insurance, which the private-pay Brookdale did not accept.

Barnfield’s close friends started calling many of the 19 skilled nursing homes in Sonoma County that do accept Medi-Cal, but none would take her. During a break in her eviction proceedings, her Sonoma County Legal Aid attorney and Brookdale’s attorneys located a bed in Novato, and she was taken there the next day.

Barnfield is unique in that she’s lived longer than most people, senior advocates say. But her predicament — running out of money and relying on federal health insurance that advocates claim skilled nursing homes avoid — is one an increasing number of people will face as a large share of the population continues to age.

Crista Nelson, executive director of Senior Advocacy Services, a regional agency that runs the Sonoma County Long-Term Care Ombudsman Program, said Medi-Cal reimbursements are far lower than what skilled nursing homes get from Medicare, which covers a resident’s medical needs and also can be used for expensive physical therapy. Because of that, she said, nursing homes will try to limit the number of Medi-Cal residents they take in.

It’s a claim strongly rejected by the trade association that represents most of the skilled nursing homes in California.

Deborah Pacyna, a spokeswoman for the California Association of Health Facilities, said statewide admissions records show that 15% of residents in skilled nursing homes are on Medicare, while 73% are on Medi-Cal or Medi-Cal-managed care plans.

“It’s hard to argue that facilities are limiting access when 3 out of every 4 patients is obtaining health care coverage through Medi-Cal,” Paycna said in an email.

Pacyna said the Bay Area, in general, is among the most affected regions in California for available skilled nursing beds because of its dense population and the lack of new nursing home construction. High real estate costs and excessive regulation by the Office of Statewide Health Planning and Development inhibits new construction, she said.

“In Sonoma County alone, there are just 1,400 beds to serve a half million people and an exploding elderly population,” Pacyna said.

According to Nelson, who runs the county’s Long-Term Care Ombudsman Program, Sonoma County is home to 21 skilled nursing and 169 assisted living facilities. Assisted living facilities or long-term care facilities are not covered by Medicare or Medi-Cal because they technically are not medical beds, she said.

Medicare will pay up to 100 days of care in skilled nursing facilities if a patient has a “qualifying stay” after being discharged from a hospital, she said. Of the county’s 21 skilled nursing facilities, all but two are Medicare and Medi-Cal certified.

In total, Sonoma County has 1,463 skilled nursing beds authorized to accept Medi-Cal reimbursements. Nelson said the most common way of entering into a skilled nursing facility is by being discharged from a hospital, with Medicare covering the first 100 days. After that some patients are switched to Medi-Cal and become a financial liability for the facility, she said.

“If you have no assets or means to pay, Medi-Cal will pay that, but the Medi-Cal reimbursement is significantly lower,” she said. “They try to discharge people because Medi-Cal doesn’t pay as much.”

When Mabel Barnfield sold her home off Bennett Valley Road, she walked away with about $160,000 because she had to pay off a $250,000 loan she took out during the recession. She sold the home for about $450,000, a price that was well under market value because of deferred maintenance, said Marianne Dolan, a close friend and former real estate colleague who has been helping Barnfield and her sister, Betty James, through the eviction process.

Dolan said since last fall she tried to find a local skilled nursing facility that would take Barnfield in, but the answer was always the same. She said she was upfront about Barnfield’s Medi-Cal coverage.

“I was telling them she needed a Medi-Cal bed,” said Dolan. “They would say ‘we’re no longer accepting long-term beds,’ ‘we just filled our last bed’ or ‘we’re completely full and have no beds available.’ But they would encourage us to call back later.”

“I would said, ‘Why, because someone will probably die?’ ” she said.

James, who is 90 and lives on her own in southeast Santa Rosa, was unable to care for Barnfield. With $160,000 in the bank, Barnfield entered Brookdale Fountaingrove in 2013.

Heather Hunter, a spokeswoman for Brookdale, said in an email that Barnfield “was a beloved resident” in the assisted living portion of Brookdale Fountaingrove and that staff went “above and beyond” to help her find an alternative place for her to stay once she could no longer meet her financial obligation. That included providing resources and referrals to other nursing homes, she said.

“Our staff has cared for her and wanted the best outcome for her,” Hunter said in the email. “Since this community is not Medi-Cal certified it cannot accept Medi-Cal as a form of payment. Therefore, continuing with Brookdale was not an option for Ms. Barnfield.”

But advocates say that even finding a bed in facilities that accept Medi-Cal is extremely difficult for people who, like Barnfield, have run out of money.

Paul Dunaway, director of the county’s Adult & Aging Division, said coming up with alternatives to costly institutional care is becoming increasingly important. He said the county’s population of older adults rises by about 1% each year.

Less than 10 years ago, 20% of county residents, about 102,000, were 60 and older. In 2017, those 60 and older numbered 132,000 or 26% of the population.

“We do not have the right kind of housing for these people,” he said.

https://www.petaluma360.com/news/9562792-181/medi-cal-recipient-101-evicted-from