Monday, September 24, 2007
As older adults make up a growing segment of the U.S. population, there is an increasing emphasis on services that help keep seniors independent, living with families or living with caregivers instead of in skilled nursing or assisted-living facilities.
Adult day services have emerged as a cost-effective solution for families struggling to care for aging family members while balancing their own needs.
Here's how it works: Caregivers drop off their parent, spouse, relative or friend at an adult day center for the day. The individual enjoys meals and activities with other seniors and takes advantage of potential services such as transportation to appointments and help with bathing and other daily or medical needs.
The perks: Families or spouses don't worry, participants are socially active and the average cost, about $56 per day, is significantly less than skilled nursing care, assisted living and usually home health care.
The number of adult day centers in the U.S. grew rapidly from about 18 in 1974 to more than 3,400 in 2002. Yet that still was less than half of the number of adult day centers needed nationwide, according to a 2002 study conducted by the Partners in Caregiving program at Wake Forest University School of Medicine.
That need extends to the Yampa Valley, where senior service and health care providers are in the initial stages of planning an adult day program at The Haven Assisted Living Center in Hayden and are considering the potential for adult day services in other parts of the valley.
The Haven program will be for community members and will be located in the planned community center addition to the facility. The Visiting Nurse Association, which owns and operates The Haven, hopes to have the adult day center open by the time construction is complete, hopefully by the end of next year.
"Having a program like this is so important when your mission is to preserve independence," said Haven director Karen Burley, who is leading the planning effort. "That is the culture change for senior services - (determining) how we can keep people home longer and out of institutions."
Gauging need, benefits
A senior task force made up of individuals working in health or senior service fields meets bimonthly at The Haven to discuss gaps in senior care throughout the valley. In order to gauge the overall demand for adult day programs and the specific services needed, the task force has distributed a survey to health care providers, case managers and other groups who work with the elderly in determining care options.
Adult day services typically operate on a social or medical model or combination of both. Many centers offer nonmedical services such as transportation, meals and social activities. Other centers may have a nurse on staff to administer medications, monitor weight and blood pressure and help with other medical needs.
A study found people attending adult day programs range in age from 18 to 109 with an average age of 72. More than half have some form of dementia, and many participants typically need help with eating, walking, bathing and other personal needs, according to the study by Partners in Caregiving, which is a national resource center for adult day services.
The study also found that many participants are frail and need supervision or are at risk of being socially isolated.
"To me, the biggest benefit for the person is it gets them in back into the community to be with friends and meet new people," said Nancy Cox, director of the Partners in Caregiving program, who also directed the study. "It's a therapeutic environment as opposed to sitting at home in front of the television set or just being alone."
Caregivers, whether headed to work or taking a much-needed break from caregiving responsibilities, enjoy peace of mind knowing their parent, spouse, relative or friend will be safe.
Adult day centers typically are open Monday through Friday for eight or more hours, although some offer overnight care and emergency respite. Programs serve, on average, 25 people each day, according to the study.
Fees for adult day programs vary depending on the services offered, but costs average about $56 per day.
Most adult day programs are nonprofit and rely on third-party public reimbursement for about 38 percent of their revenue. Some states, including Colorado, have Medicaid waiver programs that reimburse costs for qualified individuals.
Medicare may reimburse costs for particular services, such as physical or speech therapy, that are offered by an adult day center and meet Medicare requirements, but, in general, the program does not cover adult day services.
Cox is optimistic that will change following a demonstration program the federal government has implemented to look at reimbursement possibilities.
"When that happens, that really is going to open up a funding stream for this service that has not existed," she said.
Other public reimbursement dollars for adult day services come from the Older Americans Act, the Veteran's Administration, the U.S. Department of Agriculture and other organizations. Additional revenue may come from grants, donations and additional fees from ancillary services such as transportation.
About 35 percent of adult day service revenues come from private, out-of-pocket payment. Most long-term
care insurance plans now provide reimbursement for adult day services, though many older adults do not have this type of insurance, Cox said.
The Yampa Valley, which already is seeing an increase in the number of retirees and older adults, is not immune to national trends.
Most baby boomers will turn 65 after 2010, and by 2030, there will be about 70 million people 65 and older - more than twice the number in 2000, according to the U.S. Department of Health and Human Services.
In addition to economic concerns, the projections raise social questions about the types and quality of services that will meet the needs and lifestyles of a new aging population.
"You have a generation that's always been the go-getters and the changers of policy," Burley said. "I don't know that baby boomers will be content to follow the institutional way we do things now."
This leads to the challenge, particularly in rural areas, of filling gaps in the continuum of long-term care choices that help residents age comfortably and happily. Providing adult day services is an important part of overcoming that challenge.
The AARP's Public Policy Institute contributed to this report.