be receiving some form of care. If not adult day care, then they would be in a nursing home. Is that correct? Ms. KURLAND. No. Actually, what I am saying is that 100 percent are in need of the service, but 93 percent have been determined to be living at home and at risk rather than coming out of nursing homes. It is a little different. All individuals entering medical day care are considered basically in need of care, but there are three different groups. One is in crisis and enters from the home, one is at risk of going into a nursing home or hospital, a third group is inappropriately placed in a nursing home and could potentially use care in a medical day care center. Maybe I confused you on that. All people require care as determined by our teams. We prior authorize all of our services, and they all meet the criteria which says they are at risk. Senator BRADLEY. And the 93 percent figure is what? Ms. KURLAND. Are living in the community and are in crisis. The remainder have come out of nursing homes or hospitals or are at risk of placement. Senator BRADLEY. What other comments do you have to the contentions that HCFA made this morning? Ms. KURLAND. Well, I guess what disturbs me is they seem to treat medical day care only as a part of the total package of services under these waivers. First of all, they have never looked at it as an individual service, and I don't believe under Channeling they have ever looked at it as a single service. It is very important in its own right. Secondly, the fact that in our waivers individuals must meet a nursing home level of care indicates that we are targeting individuals appropriately. We are not adding a group of people who would not be served otherwise. Senator BRADLEY. So that under the waiver programs, you are definitely displacing individuals who would be in the nursing home, because that is the criterion for the waiver. Ms. KURLAND. But I don't believe they have any data on the service itself within the waivers. The report they referred to has not been shown to us. We have never seen a final copy of that report, so I really don't feel they have adequately collected data on this service area or on any other services within the waivers. Senator BRADLEY. And every year in the waiver, you submit a report that contains what information? Ms. KURLAND. We submit a breakdown of costs of specific services annually. Additionally, at the end of three years, we have to basically reapply to continue these waivers, and our elderly program was renewed for five more years, so we are in our sixth year of service now. We have three small model waiver programs where we serve very sick people. Two of those have been extended, and the newest is, of course, our AIDS program. But we have to submit annual reports and they monitor us. Region II comes in and monitors us annually on all of our programs. So, they are very much aware of the services we provide. They have never disapproved anything. They have always given us superlative ratings on all of our programs. So, obviously, they are very supportive of these kinds of community services, a fact that she really did not attest to too satisfactorily. Senator BRADLEY. And just once more the numbers. The nursing home patient annual net cost is $14,664? Ms. KURLAND. Correct. Senator BRADLEY. And the cost of meeting the needs of that individual if the individual resided in the community and had adult day care would be $4,800? Ms. KURLAND. Yes, that is correct. Senator BRADLEY. So that if you were looking at individuals and say is it more efficient to be in adult day care versus being in a nursing home, you save essentially $10,000 per person? Ms. KURLAND. That is how it appears to me. Senator BRADLEY. Then, the other figure that I would call attention to in your testimony is the cost of medical day care in New Jersey at $31 average per day, and that compares on the home care side at $9 to $30 per hour. Ms. KURLAND. Correct. Senator BRADLEY. So that among the range of services, adult medical day care is clearly the most cost efficient. Ms. KURLAND. If a person is able to leave the home and get the services in a medical day care center, the personal care, nursing services required, it certainly is a very cost effective and efficient way to go. Senator BRADLEY. In addition to the personal cases which I think were really excellent-I applaud you for putting them in-I think they make it real, as the first witnesses did, the other number that my eye caught in the testimony is that, 31 percent of those involved in medical day care never were married. Ms. KURLAND. That is correct. Senator BRADLEY. So that means probably-— Senator BRADLEY. That there is no one in the world with whom they have any kind of association or relation whatsoever with the exception of maybe the friends or neighbors that they have made over the years, right? Ms. KURLAND. Yes. Senator BRADLEY. You point out that over 88 percent of the people were not married at the time of the survey 41 percent of these were widowed and 31 percent never married. So, this really means that if they don't get either a combination of adult day care medical services and/or home care, they just can't make it. Ms. KURLAND. That is true. Senator BRADLEY. They are going to end up in a nursing home, and these are largely elderly women who are alone in an apartment or small house somewhere and increasingly isolated by deteriorating health. Ms. KURLAND. That is correct. Senator BRADLEY. Well, Ms. Kurland, I think that your testimony and the statistics that you provide not only in terms of cost effectiveness for adult day care but also in terms of human need are really compelling, and I think you have helped Senator Melcher and I build a case here for what we are trying to do. Thank you very much. Ms. KURLAND. Thank you very much. The CHAIRMAN. Thank you, Ms. Kurland. We will keep this hearing record open for 10 days for any additional comments or testimony that is written that anyone would care to make. With that, the committee is adjourned. [Whereupon, at 12:14 p.m., the committee adjourned, to reconvene subject to the call of the Chair.] The American Pharmaceutical Association (APhA) is pleased to submit APhA shares the sentiments you expressed in your opening statement at the In the remainder of this letter, we will address why we believe that any legislation addressing the issue of long term care should explicitly recognize the need for pharmaceutical services. More specifically, APhA believes that if you proceed with S. 1839, the "Medicare Adult Day Health Care Amendments of 1987", it should include pharmaceutical services in its description of the medical and other health care services that should be provided in adult day health care centers. The term "adult day health care" is defined in S. 1839 as "a program of medically supervised, health and health-related items and services furnished by an adult day health care center in an ambulatory group care setting...". These services are enumerated and include medical, psychological, nursing, social, nutritional and other related services. However, there is no mention of pharmaceutical services, which are provided by pharmacists. (101) |