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Aging Well

Adult day-care centers face recession-driven funding cuts

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By Paula Span
Kaiser Health News
Tuesday, December 1, 2009

"Scrunch your face up like a raisin, and then open your jaw and stick out your tongue and go aaahhhh," says the yoga instructor. Her four students, one in a wheelchair, break into giggles.

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Wrist circles, torso twists, seated leg lifts: The class aims to help these older women at Senior Care, an adult day-care center in Montclair, N.J., maintain strength, flexibility, balance and calm.

"Oooh, that feels good," says Delores Muse, leaning forward. "I can feel the stretch."

Until March 2008, Muse was an active 59-year-old, working full time as a secretary. Then she suffered a major stroke and ended up in the hospital for a week and a rehab facility for a month. Her only child, Jameel, moved back into her house in West Orange, N.J., to help care for her. Afraid to leave her alone because of lingering cognitive deficits, Jameel, a 34-year-old financial analyst in Manhattan, tried to work from home but found it so difficult he feared he might have to move his mother to a nursing home.

Instead, he enrolled her in Senior Care, where she spends four days a week doing art projects and word puzzles, walking with friends and listening to visiting musicians. A van picks her up each morning and takes her home at the end of the day. The center's nurses measure out medications, monitor their clients' vital signs, arrange for them to be ferried to physical therapy appointments, and work with the staff nutritionist to tailor their meals.

But adult day care may soon become harder to find and afford. The almost 4,000 state-licensed centers around the country rely heavily on funding from state legislatures and charities, which have been hit hard by the recession. Advocates for adult day-care programs are pushing to include them in federal health-care overhaul legislation while also lobbying state legislatures and suing state regulators to keep centers from shutting their doors.

"Governors are scrambling to reduce deficits, and they're going after the programs that aren't mandated by law," says Sara Myers, managing director of the National Adult Day Services Association, based in Seattle. "Adult day is optional."

Vulnerable finances

Adult day programs began multiplying in the 1970s, when state and federal laws expanded funding for community-based services for people with disabilities, chronic disease or cognitive impairment. Although the programs vary greatly, most provide social and medical services, as does Senior Care, a nonprofit center serving about 130 clients ranging in age from the 50s through the 90s. Clients are referred by social service agencies, Medicaid case managers, rehab facilities and senior centers. Some programs open early and stay open late, and even operate on weekends, to accommodate the work schedules of family caregivers.

Not only do adult day services keep caregivers in the workforce, advocates say, they also provide a cost-effective alternative to a nursing home, which runs an average of $198 a day for a semi-private room, or to a home-health aide, at $21 an hour.

By contrast, a full day at an adult day center, on average, costs $67, according to the 2009 MetLife Mature Market Institute survey. But that number conceals wide regional variations, with average prices ranging from $27 a day in Montgomery, Ala., to $150 in Vermont. In the District, the average is $96. Senior Care, which Delores Muse attends, charges $90 a day.

Nationwide, 35 percent of those expenses is paid out of pocket by participants. Much of the rest is financed by state Medicaid and local programs and federal sources including the Older Americans Act and programs run by the Agriculture and Veterans Affairs departments. Foundations and charities chip in, too.

But reliance on public funding for adult day-care services has made them vulnerable. In Washington state, a lawsuit has warded off a move to deny adult day services to residents of state-funded residential care homes. In California, lawsuits by community service advocates thwarted a cut in the Medicaid reimbursement rate and a move to limit attendance to three days a week. Minnesota decreased its reimbursement rate and made eligibility requirements more restrictive. New York, Illinois and other states are also pursuing reductions.


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