The CHAIRMAN. To begin this morning's hearings, we are going to watch a videotape. Gretchen Meinke who is Administrative Director of the Adult Day Health Network of United Way of San Francisco will be introducing the tape. Gretchen, we would like to have you do that right now. STATEMENT OF GRETCHEN MEINKE, ADMINISTRATIVE DIRECTOR, SAN FRANCISCO ADULT DAY HEALTH NETWORK, UNITED WAY MS. MEINKE. Thank you very much. Senator Melcher, as you are aware, long-term care of the frail and chronically ill elderly is one of the major issues facing our nation today, and I would like to commend you for your efforts in working on this important issue. Adult Day Health is one important community based long-term care option, and the program provides health, social, and rehabilitative services for frail elders and disabled adults in a community center. The program also provides important support and respite for care givers, as the videos that we are going to see today will show. San Francisco has a city-wide network of centers, and, together, they provide health, social, and rehabilitative services to over 1,200 frail elderly individuals and disabled adults. The films that you are going to see now include a portion of two spots. The first was prepared by KGO-TV and aired on the nightly news. It depicts St. Mary's Adult Day Health program which is a hospital-based program in San Francisco. The second was prepared by United Way as part of their annual campaign and emphasizes support for the care giver. Both highlight the value of Adult Day Health in San Francisco, and I am pleased to have a chance to show them to you. [The showing of video tapes proceeded.] [Transcripts of video tapes follow:] TRANSCRIPT OF VIDEO ON ADULT DAY HEALTH CARE Channel 7 News, (ABC) KGO TV, San Francisco (11/6/86) Anchor: "Help is available for elderly people who don't want to go in a nursing home but may be unable to take care of themselves in their own homes. Channel 7's Ed Baxter reports on a possible solution being tried now in San Francisco." Reporter: "78-year-old Odessa Curie would be in a nursing home if it weren't for St. Mary's Adult Care Center and for the strong will of her son, Harold." Harold: "I'm the only child she has and I see many children that use the hospitals and convalescent homes as a dumping ground; I'm going to stay with her until I just can't do any more. I couldn't thank my mother for the times that she had to get up at night, or take me to the doctor; when I hurt myself she'd wrap up the wound and so forth." Odessa Curie: "I'm proud of him." Reporter: "Our society is growing older; census bureau figures show by the year 2000 the over-75 age group will be the second fastest growing. This center, St. Mary's, is part of a network of seven in San Francisco, and is being used as a model for other parts of the country as a way to let our elders stay in a home environment rather than having to go to a nursing home full time." John Daw, Director of St. Mary's Adult Day Health Center: "Primarily they are here to receive skilled services: nursing, physical therapy, occupational therapy, speech therapy, social services, and recreational services. That also gives the families respite which is very important when they have 24 hour responsibility for a frail elderly person." Reporter: "So it helps working couples the same way child care centers do at the other end of the age spectrum. People who run the centers say that it is a lot less costly than full time nursing care. Their fee schedule is based on a sliding scale and subsidized by charity and private sector organizations. For Odessa, it means no nursing home." In San Francisco, Ed Baxter, Channel 7 News. United Way Spot: Narrator: "For many people the problems of general aging are One program that is making a difference is the San Francisco Mrs. Edith Fried: "My husband was a newspaper critic for over 50 years, a music critic and arts critic for first the Chronicle and later on for the San Francisco Examiner and he loved his work. And the strange thing now is that he never even listens to music; there is nothing of the intellectual ability left in him. I would never send him, as long as he has any feeling of being a person himself; I would never send him to an institution where he is taken care of day and night. I would not completely detach myself from the care, so I think this day care center is just the right thing for both of us. The center has given back to me a few hours every day at least four times a week now, a few hours that I can call my own and act as a normal healthy person. As a caregiver, you have the feeling that you are taking care of somebody who is very dear to you, almost like taking care of a child, but you have the frustration of trying to take care of someone who is gradually deteriorating. One day he can do something and the next day he can't do it anymore. He likes it very much and every morning he is looking forward to going. These people are doing the greatest charitable act that I can think of and I am deeply grateful to them. They have infinite patience and are forever friendly, cheerful, and uplifting and all of them are that way. I don't think I could have lasted as long as I have, now almost the 10th year, if I hadn't discovered the center for the last two years. This has given back part of life for me that I think everyone is entitled to." The CHAIRMAN. The committee will be in recess for two or three minutes while we remove this equipment. [Recess taken.] The CHAIRMAN. The committee will come to order. Ms. Meinke, thank you very much for these very informative video tapes. I believe seeing is believing, and through your video tapes, we have been able to see and believe, see what can be done, what is being done in San Francisco, and believe that it is the right thing to do and should be broader to reach every family with an older American or a disabled American who, ideally, would have access to such day care centers as you have portrayed in your video tape. Senator Shelby. STATEMENT BY SENATOR RICHARD SHELBY Senator SHELBY. Thank you, Mr. Chairman. I want to again express my appreciation to you for calling this hearing. Adult day health care, I believe, is a sensible approach to meeting the needs of our adult citizenry, and it is an important step in addressing the problem of providing long-term care. Your leadership on this subject, Mr. Chairman, is truly commendable. I was proud to co-sponsor your bill, S. 1839, the Medicare Adult Day Health Care Amendments of 1987, and would encourage my colleagues to support this vital legislation. Much attention has been focused recently on the need to ensure that every American has access to our health care system. Unfortunately, many individuals are barred from receiving medical attention due to their inability to pay and lack of adequate insurance coverage. Currently, we are waiting for Congress to take final action on important steps toward expanding Medicare coverage. Last year, as we all know, the Senate passed S. 1127 which would allow Medicare to pay a portion of the costs of catastrophic acute care. We must continue our efforts along these lines. Throughout the debate on the catastrophic bill, we heard of the even more serious dilemma of how to finance long-term care. The elderly segment of our population is growing more rapidly than any other group. As our population continues to age and the baby boom generation matures, the need for an effective means of providing coverage for the costs of long-term care will be increasingly imminent. Adult day health care is a common sense approach to meeting this challenge. An adult day health care center provides the maximum benefit to participants, families, and the community. We all recognize the importance of maintaining our independence. Adult day health care facilities offer impaired adults medical and social support-related services, thereby preventing or delaying placement in nursing homes. This affords individuals the opportunity to stay with their families in their communities. Many of the primary care givers of elderly individuals are family members. These care givers are usually working adult children who must frequently quit work or reduce the number of working hours to care for their aging relatives. And regardless of this effort, most relatives are not medically qualified to provide the type of care needed by elderly relatives who are often afflicted with such ailments as Alzheimers disease, stroke, head injuries, or other physical or mental impairments. Most adult day health care centers are staffed with trained professionals who are qualified to provide medical care, speech or physical therapy, or whatever the individual need may be. Such assistance is given in accordance with an individual plan of care in a protective group setting. But these centers offer participants more than health-related care. Adult day health care facilities are centers of socialization as well. With increased interaction with family, friends, and peers, an individual is able to assert a higher degree of independence than if he or she were confined to a nursing home. In these days of budgetary restraint, it is rare when a solution presents itself as both humane and cost effective. However, adult day health care can prevent or delay institutionalization of elderly adults in nursing homes and can allow participants to remain in their homes and communities. This ultimately saves dollars, for the cost of care provided in an adult day health care center is usually far below the price tag attached to nursing home care. Long-term care is a challenge we must face today. Adult day health care is an important step in addressing the needs of our elderly population. Thank you, Mr. Chairman. The CHAIRMAN. Thank you, Senator. Senator Chafee. STATEMENT BY SENATOR JOHN CHAFEE Senator CHAFEE. Thank you, Mr. Chairman. First, I want to thank you for holding this hearing on adult day health care, and I want to commend your efforts in examining possible solutions to this multi-faceted problem of long-term care. We are all keenly aware of the difficulties the elderly face in paying for long-term care. It is critical, I believe, that we find a practical and financially sound solution so that elderly and disabled individuals have both high quality and appropriate long-term care services. I believe that adult day care must be a significant part of any solution. One of our most important assets we have in our country is the family. I believe we should do everything possible to ensure that families can remain together as long as possible. Unfortunately, and this is absolutely true of the Federal policies currently, they represent an all or nothing proposition. To obtain long-term care assistance today, an individual must spend all of his or her assets and go into a nursing home or institutional setting before Medicaid will help. We do nothing to give families assistance such as day care or respite care to support their efforts to keep a parent or other loved one at home. It is for this reason that I am pleased to report that I have joined as a co-sponsor of the Medicare Adult Day Health Care Amendments of 1987, S. 1839. This legislation would provide additional |