After a car accident left him a quadriplegic, Luis Cervantes chose to return to his hometown after recovering.
But the 29-year-old was reluctant to ask his mother and sister for physical support. He stopped accompanying Schirmer on her outings. Cervantes eventually suffered from suicidal thoughts and was admitted to the hospital again with a urinary tract infection.
Luis Cervantes (left) and Angel Bastos at Laramie House.
(Robert Gauthier/Los Angeles Times)
He did not decide to return home, but was dissatisfied during his several months in the nursing home. By then, he had heard about Laramie House, a lesser-known type of congregate living medical facility.
The six-bed facility in Chatsworth accommodates people who are ventilator dependent, quadriplegic or have other serious needs in a small environment that feels like a suburban home. We provide daily medical care to support people’s spiritual awakening.
“I’ve been fighting to get into this place ever since I found out about it,” said Cervantes, who moved this fall.
Such a facility arose in the San Fernando Valley decades ago, the brainchild of a nurse who cared for quadriplegic patients. And operators say they have relied on the same level of payments from the state for decades, a situation they argue clouds their future.
“We haven’t had a raise in 40 years,” said Sian Welch, CEO and administrator of New Start CLHF Independent Training Center, which operates three facilities including Laramie House.
If this situation continues, “we will have to close our doors,” she said.
Administrator Sian Welch stands in the back, talking to residents and carers at the home.
(Robert Gauthier/Los Angeles Times)
California had been planning to increase reimbursement rates for facilities like Laramie House since January, but the state was headed toward the red after voters approved Proposition 35 in November.
The ballot measure aimed to secure funding for Medi-Cal, California’s Medicaid program, by making permanent an existing tax on managed care organizations.
It was supported by a powerful coalition of medical groups, including the California Hospital Association. and California Family Planning Affiliates. The ballot measure also outlined plans to spend the money, including increased payments to many health care providers who see Medi-Cal patients.
Suicide prevention and crisis counseling resources
If you or someone you know is struggling with suicidal thoughts, seek professional help by calling 9-8-8. The nation’s first national three-digit mental health crisis hotline, 988, connects callers with trained mental health counselors. You can reach the Crisis Text Line in the U.S. and Canada by texting HOME to 741741.
That would alleviate the shortage of health care providers who accept Medi-Cal and help patients, advocates said. But state lawmakers had already budgeted for that tax revenue, and the passage of Proposition 35 revealed other tax revenue plans that weren’t included in the ballot measure.
State Sen. Caroline Menjivar (D-Panorama City) said she warned her colleagues that passing the bill would nullify valuable investments. For many people with complex needs, facilities like Laramie House are “the last line of defense,” she said.
More than 250 such facilities have been licensed in California, more than half of them in Los Angeles County, according to the latest state data available. Mariam Voskanyan, president of the Congregate Living Health Facilities Association, said there may be fewer facilities operating now, based on efforts to reach out to them.
Mary Jane Trifon helps Tyler Smith while Angel Bastos looks on.
(Robert Gauthier/Los Angeles Times)
Such facilities have not received Medi-Cal reimbursement rate increases since they were established in the 1980s, according to the industry group Congregate Living Health Facility Assn. The Department of Health Services said the facility’s reimbursement rate has remained unchanged since at least 2012, based on available documentation.
Daily rates for these facilities range from less than $92 to about $490, depending on the level of care needed, compared to daily rates for skilled nursing facilities of $292, according to a September summary from the Department of Health Services. $610.
However, these homes are supposed to provide a higher level of medical care than nursing homes. Before Prop. 35 passed, lawmakers agreed to raise rates starting in 2025 to bring them closer to parity with nursing homes, increasing most rates by about 60%. The total cost was $16 million a year, half of which was covered by federal funds, according to the Department of Health Services.
Supporters of Prop. 35 say the Legislature could still choose to increase funding for the facility by allocating money from the state’s general fund, which would be appropriated in part from tax revenues. But representatives from both families were unhappy about having to lobby again to get funding.
And as President-elect Donald Trump heads for a second term, health experts predict the federal government could make deep cuts to Medicaid, forcing programs to compete for less Medicaid dollars. I am doing it.
“It would create an environment where the entire Medicaid program is potentially at great risk,” said Mayra Alvarez, president of the Children’s Partnership, one of the groups opposing Proposition 35.
The congregate living medical facility grew out of the efforts of Mary Williams, a Northridge nurse who was frustrated with the options available to her quadriplegic patients when they were ready to be discharged from the hospital.
Williams began opening residential facilities in the San Fernando Valley to care for patients in the 1980s, but he sometimes clashed with Medi-Cal officials who expressed concerns about regulatory requirements. At one point, when government officials intervened to remove residents from their homes, one protested by parking his wheelchair in a Northridge driveway, telling the Times: And I’m not moving. ”
Luis Cervantes, right, adjusts his wheelchair to a prone position with others at Laramie House.
(Robert Gauthier/Los Angeles Times)
The Times reported at the time that regulations governing the housing had not yet been drafted in Sacramento, but Welch said his mother, Mary Williams, had been working with Medikal from the beginning.
Now, “We’re licensed by the California Department of Public Health, but it looks like a home and feels like a home,” said Irene Tokar of the Congregate Living Health Facility Assn. Board member. Residents can “go to church, go to the movies, go to lunch, have family come visit.”
Cervantes said that less than a week after she moved into Laramie House, she and her housemates boarded a bus to the mall. “The fact that I know I have the freedom to go out if I need to makes a huge difference to my mood.”
Tyler Smith, 42, contracted West Nile virus and was in a coma for several weeks. He is now a quadriplegic and relies on a ventilator. She said it was a “special hell” while she was in the hospital, as her twin sons couldn’t come visit her.
At Laramie House, his days include physical therapy, visits with family and friends, and Bible study group meetings. Technology has allowed me to dictate texts and continue working as a consultant. He can now breathe on his own for up to six hours, and his goal is to stay at Laramie House “until he recovers.”
“It would be a disaster if this place suddenly had to close,” he said.
Karen O’Loughlin gently moves her son Trevor Hillegas’ arm.
(Robert Gauthier/Los Angeles Times)
Mary Jane Trifon assists Tyler Smith.
(Robert Gauthier/Los Angeles Times)
Welch said she is in debt because nursing costs have gone up. Homes must meet state requirements for staffing, including nurses and certified nursing assistants. Welch said she also pays for recovery nursing assistants who help residents regain the ability to move and stand.
“If we had to cut everything, it wouldn’t be the way it was supposed to be,” Welch said.
If the state’s tax rate is not increased, more homes will be closed and residents will be evacuated, Voskanyan said. Most are self-sufficient and “have no other source of income to sustain us,” she added.
Her association spent $130,000 lobbying on several bills during the last California legislative session, including Menjivar’s bill, which would require a study of the operating costs of such facilities.
These homes are also embroiled in problems in other states. Residents like Cervantes have access to congregate care facilities through a waiver system that allows Californians to receive Medicaid benefits for home health care, but demand has exceeded capacity, resulting in long waiting lists. I am doing it.
For example, Welch said Angel Bastos’ health insurance turned her down when she first applied to move in, and she had to wait more than a year to get a waiver instead. Bastos, who was paralyzed for nearly a year after surviving the shooting, said she suffered humiliation in the nursing home, including severe pressure sores on her back.
Angel Bastos shares a laugh with Mary Jane Trifon, who says she was humiliated at the nursing home.
(Robert Gauthier/Los Angeles Times)
“I felt like a cow.”
At Laramie House, the 37-year-old celebrated his wedding in the backyard. He rode his wheelchair to the Starbucks down the street. He stood up for the first time in years.
“It feels like you’re getting ready to go home,” Bastos said. “Or feel at home. That’s who you are.”
Times staff writer Melody Petersen and researcher Scott Wilson contributed to this report.
