OPENING STATEMENT OF SENATOR JOHN HEINZ, RANKING MINORITY MEMBER FOR THE SPECIAL COMMITTEE ON AGING HEARING ON ADULT DAY CARE April 18, 1988 Mr. Chairman, I commend you for your timeliness and foresight in holding this hearing on Adult Day Care, and for your sponsorship of the Medicare Adult Day Health Care Amendments of 1987. I am pleased to be a cosponsor this legislation, which would establish Medicare coverage for up to 100 days each year of health and rehabilitative day care for Medicare eligible persons over the age of 18. Throughout our recent consideration of legislation to protect older Americans from Catastrophic Health Costs, we heard repeatedly that the greatest financial risk borne by the elderly is long term care. We also know from many years of hearings and countless studies that the aged and disabled strongly prefer any form of long term care that will allow them to stay at home, rather than be institutionalized. Adult Day Care is one of several essential community based long term care services, such as home health and home supportive services, which are responsive to these needs and preferences of the elderly. We have taken some significant steps toward improved coverage with the catastrophic care legislation approved by the Senate on October 27th. In that legislation, we improved the short term Home Health and Skilled Nursing Facility benefits provided by Medicare. Nonetheless, like Hercules in his struggle against Hydra, Congress faces a monster with more than one head. Providing for short-term acute care costs still leaves American families facing the greater financial catastrophe of a long-term, chronic illness. Mr. Chairman, the typical recipient of Adult Day Care services is a woman over 73 years of age with an income of less than $500 each month, who relies upon her children to care for her around the clock. Adult Day Care centers offer critical daily services which help family caregivers to continue the very difficult task of supporting their disabled loved ones at home, by freeing them to work and attend to other business away from home during the daytime. Without this assistance, thousands of families simply wear down and can no longer maintain their aged relatives at home. When family caregiving structures collapse, research shows, families must seek more expensive institutional care for their impaired loved ones. Despite the vital role Adult Day Care is already playing in tens of thousands of lives across the country, most long term care legislation being offered in Congress omits coverage of Adult Day Care. I believe this is a mistake. Adult Day Care is an integral part of the long term care continuum of services, and should be recognized as such by any public chronic care program Congress may enact. Adult Day Care can in fact meet the health and rehabilitative needs of many persons who would otherwise require care in a skilled nursing facility, including patients suffering from Alzheimers' disease. However, I think we should be careful in drawing any conclusions about cost savings from a Medicare Adult Day Care benefit. I say this because of the very high occupancy rates that characterize most States' nursing homes, and because of the long waiting lists of elderly and disabled beneficiaries awaiting entry to those nursing homes. The fact is, we have done such a poor job of financing long term care services that new benefits are needed simply to meet unmet needs and may not produce measureable financial savings. - Yet, for thousands of elderly and disabled persons and their families, Adult Day Care can make a tremendous difference in the quality of their lives. I believe it is wise public policy to target scarce Medicare resources to support and extend the service provided by the unpaid family caregivers who now assume the great bulk of long term care responsibilities in the United States. What's more, several polls of the American public suggest strongly that taxpayers are willing to pay higher taxes to ensure that resources for long term care are not as scarce in the future as they are today. Under these circumstances, Mr. Chairman, we would be remiss if we ignored Adult Day Care services as a key component of the array of long term care services that should be covered by Medicare. Once again, Mr. Chairman, I thank you for convening this hearing, and join you in urging our colleagues in the House and Senate to join in a commitment to find a solution to the problem of long term care costs in the near future. Opening Statement of Senator Harry Reid Member Senate Special Committee on Aging April 18, 1988 'ADULT DAY HEALTH CARE: A VITAL COMPONENT OF LONG-TERM CARE" Thank you, Mr. Chairman, for providing the members of this committee with an opportunity to explore the relatively new longterm health care service, adult day health care. I would also like to extend my sincere thanks to the distinguished panel of witnesses who are lending their valuable time to help us investigate this promising form of adult health care. The video that opened today's proceedings is testimony to the positive ways in which adult day health care facilities can affect the medically needy and those who care for them. I firmly believe adult day care will prove to be an excellent form of long-term care. We will hear this morning how day health care for adults can significantly improve the quality of life for both the participants and their home caregivers, decrease medical costs by replacing or delaying nursing home stays, and decrease the number of costly visits to doctors and as well as the number of hospital stays. "Day My home state of Nevada has an ever increasing elderly, medically needy population. We have next to none of these adult day health care facilities, buy the few we have are very successful. In Reno, for example, the Washoe County Senior Center houses a very successful day health service called Break." The facility serves its maximum capacity of 23, five days a week. There is consistently a waiting list. The director of the Center is hesitant to publicize the "Day Break" service because the Center simply cannot accommodate the numbers that would be sure to respond. Plans to expand the days of service and the size of the facility are being considered, but, as usual, funding is scarce. It is obvious to me that the need for adult day health care is present, and that such facilities have the potential to decrease the health care bills of private citizens and of federal, state and local governments, while substantially increasing the quality of life for many. SENATE SPECIAL COMMITTE ON AGING HEARING ON ADULT DAY CARE STATEMENT BY SENATOR PRESSLER APRIL 18, 1988 Mr. Pressler. Mr. Chairman, I commend you and your staff for organizing this hearing on adult day care. Too often we have focused our attention and directed our resources to institutional care. With only five percent of the elderly population being in a nursing home at any given time, it becomes apparent that we must now direct our attention to community-based services. With an aging society, we can no longer allow a fragmented long-term care delivery system. The population over age 75 is increasing. These individuals are more likely to be "at risk" from multiple chronic conditions. Adult day care can be an important program to keep frail older adults in the community. Adult day care also can provide programs to the elderly with cognitive impairments, such as Alzheimer's disease. According to one survey by the National Council on Aging, it was estimated that 2,000 to 3,000 of the 10,000 to 15,000 adults currently in adult day care programs suffer from dementing diseases, such as Alzheimer's and related disorders. But many more of the estimated 1.5 to 2 million individuals who suffer from these diseases could be served by adult day care programs. Adult day care can be a valuable support to family caregivers who provide 80 percent of all health care for the elderly. Elderly participants in adult day care who require continuous supervision are able to live with spouse or children in their own homes. Adult day care programs can reduce caregiver burnout. Some view this as the most significant factor in nursing home placement. Advocates of adult day care state that this type of service is a cost effective way to deliver care to the elderly. In the state of South Carolina, an adult medical daycare package including physical therapy, meals, nursing care, personal care services, transportation and recreation costs $40 a day, as compared to a $60 charge for only the physical therapy at home. Although reports from other states such as Hawaii, New Jersey and Massachusetts have been favorable to adult day care, some public policymakers still question the validity of the research data. Extensive and comparable data often is lacking. Comparisons between the costs of day care and institutional and home care are difficult to make because the intensity of care provided at each level can vary greatly. Furthermore costs vary between day care centers which serve different kinds of individuals, provide different services or operate at different hours. Lack of adequate transportation may create a barrier to those who are disabled and isolated in the communities. These individuals would benefit from adult day care. Buses may not be designed to carry wheelchairs and buildings may not be designed for the disabled. Policymakers have been questioning whether adult care will be cost effective in reducing admissions to more expensive nursing homes. Although some may view adult day care solely as a respite or home health service, many view it as a separate service in the continuum of long-term care. Adult day care programs are multi-faceted, including medical services, counseling, rehabilitation, personal care services, meals, transportation, therapeutic and recreational services. My visit to an adult day care center at the Huron Area Senior Center in Huron, South Dakota provided me with an example of an excellent program. By watching the activities at the Huron Centers, I know that adult day care can be of great assistance to both family caregivers and participants. Adult day care can assist the elderly to maintain their independence, control, and quality of life. It can provide a way for the elderly to stay in their own homes in the community. Mr. Chairman, in a nutshell, independence, quality of life, and ties to the community sum up the advantages of adult day care. Thank you for holding this hearing to promote the dissemination of ideas on this very worthwhile and important program. |