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ADULT DAY HEALTH CARE: A VITAL
COMPONENT OF LONG-TERM CARE

MONDAY, APRIL 18, 1988

U.S. SENATE,

SPECIAL COMMITTEE ON AGING,
Washington, DC.

The committee met, pursuant to notice, at 9:35 a.m., in room 628, Dirksen Senate Office Building, Hon. John Melcher (chairman of the committee) presiding.

Present: Senators Melcher, Bradley, Burdick, Shelby, Grassley, Domenici, and Chafee.

Staff present: Max Richtman, staff director; Natalie Cannon, professional staff; Dianna Porter, professional staff; Bill Ritz, communications director; and Kelli Pronovost, hearing clerk.

OPENING STATEMENT BY SENATOR JOHN MELCHER

The CHAIRMAN. The committee will come to order.

This morning's hearing is on a partial answer to what I believe is everyone's question, and that question is, if older Americans are to be able to stay in their homes and enjoy their homes and regular community life, what can we do or what is being done to make that possible, providing they need health care? And many older Americans, as we know, all need some health care at home.

In fact, HHS tells us that there are between 4.5 million and 5 million older Americans who are at home and, for one reason or another, have to have some assistance regarding health care.

Now, it is obvious, I think, to everybody why people want to stay in their homes. It is the continuity of family life, the continuity of being part of the community-much more so than being in a nursing home. So, that is what families and individual older Americans strive to do.

Now, if we were going to start on the premise of just economics, I guess we would say, well, does this save money? And the answer to that is emphatically yes, it does save money.

And for whom does it save money? It saves money for the families, and it saves money for Medicare, and it saves money for Medicaid. So, both the individual and their families save money, but, also, the government saves money.

So, what is being done in this regard? Well, not enough, we find out, but one of the bright spots is that there are adult day care centers throughout the country. I am told there are over 1,400 adult day care centers, which is a place where an older American or a handicapped individual, regardless of age, can come and get a

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degree of care related to health and related to making life interesting.

So, some families with an adult elderly person can actually bring the person there or there is a bus that goes out or a car goes out and picks up the person or a van goes out in the case of a wheelchair and picks up the person, and they come and spend part of the day or perhaps all day in this adult day care center.

Two-thirds of the elderly who are needing some help-sometimes we call them frail—or are disabled live with their families right now. So, in many instances, it is a case of are the family members who work able to work and to be gone from the home. And who takes care of the elderly person or the disabled adult? This is a partial answer, adult day care centers.

What is the cost? Nationally, I am told that the average cost per day is $31. Now, we have to measure that against, for instance, a stay in the hospital which is a great deal more. Sometimes, this relieves the need for somebody who needs some care of having to spend extra time in the hospital. Also, obviously, $31 a day is a pretty good figure to look at in terms of what it costs to be in a nursing home which is between $60 and $70 a day.

So, adult day care centers are performing a very useful need, and they are a bright spot in how we provide for an older American who needs some health care at home, how we keep them at home and, therefore, better satisfied and save some money for both the family and the government.

Right now, adult day care programs are funded with a patchwork of funding. Maybe we can't relieve that, but there are a number of us here in the Senate, myself included, who believe that this fits into Medicare. So, we are seeking ways to do that.

Naturally, if there is another financial drain on Medicare, we have to come up with the funding for it. We recognize that, and we are looking at the means of possible funding by adding this as a part of Medicare's responsibilities and obligations.

[The prepared statement of Senator Melcher follows:]

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ADULT DAY HEALTH CARE: A VITAL COMPONENT OF LONG TERM CARE

Good Morning. I welcome everyone to this morning's hearing by the Senate Special Committee on Aging on adult day health care and its role as a vital component of long-term care.

Adult day health care is a relatively new long-term care service. As a result, it only recently has begun to receive the recognition it deserves as an option in the continuum of care.

As Congress begins serious consideration of legislation for long-term care, I feel that it is important for us to learn more about adult day health care programs around the country. How do they assist frail elderly and disabled adult participants and their family caregivers? How effective are their services in saving costs and delaying or preventing our elderly from having to enter a nursing home?

More than 1,400 adult day care programs are now in operation throughout the United States, serving more than 66,000 persons a day. Most of these programs have grown rapidly at the grassroots level over the past 10 years. They offer a comprehensive range of services, usually under the supervision of a multidisciplinary team of professionals. These include health assessment and monitoring, personal care, a hot meal, counseling, therapeutic recreation, transportation, and often physical, speech, and/or occupational therapy.

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However, adult day care programs, for the most part, lack a stable base of funding. Most are financed by a patchwork of public and private funds, philanthropic donations and private client fees. The federal share of funding sources is: Medicaid, 14 percent; Social Services Block Grant, 12 percent and Administration on Aging Title III, 6 percent. The national average cost of a day of adult day health care is about $31.

About 65 percent of the frail elderly and disabled adults who participate in adult day health centers live with family caregivers or friends. The almost constant, unpaid care given by families and friends is usually the critical factor in preventing or delaying their entry into nursing homes.

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But if adult day care is important to keep frail and disabled adults in their communities and out of institutions, adult day care is absolutely crucial to family caregivers and friends. Understandably, the life of a caregiver is fraught with stress. To a caregiver who also must hold down an outside job, the stress is almost impossible. For them, adult day health care means they can continue their jobs or go to the grocery store or even take a few hours off for some solitude in the library. For these people, adult day health care is a must.

Because I know that adult day health programs offer not only professional but compassionate, individualized and costeffective care, I firmly believe we must make it a high priority as an integral part of long term care.

I would like to commend some of our witnesses here today, as well as others in the audience, for their commitment and dedication in the adult day health field. They are the ones that help make the difference in assisting our impaired elderly to live independently in their communities as long as possible.

I am looking forward to hearing from today's witnesses who will tell us more about adult day health care, its benefits, effectiveness and the need for its services.

Our first witness today will be George and Jean Glakas. George, who had a stroke six years ago, now attends the adult day health center in Annandale, Virginia. His wife, Jean, carries on the family business, which she could not do without day health care for her husband.

Our next witness is Lou Glasse, president of the Older Womens' League, who will testify about the role and stress of family caregivers and their need for support.

Then we will hear from Don Peterson, administrator of St. John's Nursing Home in Billings, Montana which also has an adult day care program. He also represents the American Association of Homes for the Aging which operates adult day care programs in about 320 of their facilities.

Kay Larmer will testify next as coordinator of adult day health programs in Fairfax County, Virginia and also as chairperson of the National Institute of Adult Daycare, an organization of professional persons who work in this field.

In addition, we'll hear from Ellen Shillinglaw, who will speak on behalf of the Health Care Financing Administration as Director of the Office of Legislation and Policy.

Our final witness will be Carol Kurland, Administrator of the Office of Home Care Programs for the state of New Jersey. She will describe how their effective Medicaid-funded program works as well as its benefits to participants and caregivers.

We have an interesting morning ahead of us so I suggest that we begin.

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