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Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals. [ABSTRACT FROM PUBLISHER]

Objective: This study examined the effects of California's 2005 Mental Health Services Act (MHSA) on the use of mental health-related emergency department visits. It focused on one MHSA program, the full-service partnership program, and hypothesized that individuals with public insurance who participate in the higher-quality full-service partnership program would have fewer emergency department visits compared with clients with public insurance who receive usual care. Methods: Data were obtained from the Short-Doyle/Medi-Cal (Medicaid) file, the Data Collection and Reporting system, and the Consumer and Service Information System, all maintained by the California Department of Mental Health. The analytic sample covered 931,218 observations (155,203 adults) ages 18 and older from January 2007 to June 2008. The data represented clients from seven counties, which made up 48.5% of the California population. Fixed-effects logistic regression was used and included a continuous measure of time, in quarters, in the full-service partnership program; separate quarter indicators; and quarter-county interaction terms. The model thus controlled for both time-invariant personal characteristics (including personality as well as psychiatric and medical history as of entry into the study) and all time-varying county-level characteristics. Results: Relative to persons receiving usual care, the odds of full-service partnership participants visiting the emergency department were 54% less after four quarters of treatment and 68% less after six quarters. Conclusions: The full-service partnership program was highly effective in reducing emergency visits. A statewide cost-effectiveness study should be conducted to determine the economic viability of the program. [ABSTRACT FROM AUTHOR]