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.

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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

Under these

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. 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.

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 "Day 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 guality 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.

The CHAIRMAN. Our first witnesses this morning will be Jean and George Glaskas of Falls Church, Virginia.

Please proceed.

STATEMENTS OF JEAN AND GEORGE GLAKAS, FALLS CHURCH,

VA

Mr. GLAKAS. Gentlemen, I am a little nervous, so you will have to bear along with me.

My name is George Glakas. I used to be a very active man with two jobs. When I was 63, I had a stroke that left me paralyzed on my left side.

I was in the hospital for three and a half months. From there, I went to the Woodrow Wilson Rehabilitation Center in Fisherville, Virginia for three months of therapy.

I got to the point where I could take a few steps, but I needed a lot of help and spent most of my time in a wheelchair. I was glad to go home, but my bed had to be in the kitchen, and there was no bathroom on that floor.

I was in bed most of the time, because I needed so much help to get up and out of bed. It was too much for my wife. I needed to have someone with me, dress me, feed me, do everything. I was a burden.

I was miserable and depressed. I couldn't go up and down the steps in the house, so we sold the house and bought a condo where everything is on one floor. We hired people to take care of me, but it was very hard to get somebody good, and it was expensive.

Money was really getting to be a problem with my wife and I. I still was in bed most of the time, feeling unhappy and guilty. I had to depend on my wife for so much.

Luckily, I had a young wife. [Laughter.]

That wasn't planned.

Senator CHAFEE. Young and attractive wife.

Mrs. GLAKAS. Thank you.

Mr. GLAKAS. I had a good family that helped me. My sister in Maryland located the day care center here in Virginia.

My first reaction was it is not my bag sitting around with old people, but when I went in 1985, I liked it and still do. I like the staff. They care about me and help keep my spirits up. I have made a lot of friends there. It has been really important to me to have friends to sit around with and talk to about current events and lie about our women. [More laughter.]

The center bus picks me up at my door and brings me home. At the center, we do many different things. We have competitive sports we can play like bowling, golf, volley ball, football, and baseball. That doesn't mean we go out on a football field and play. This is my football. We have box hockey. We even play against the other centers.

This year, we took first place in the volley ball tournament and second place in the box hockey.

We go to a movie occasionally and then out to lunch. We have trivia games to wrack what is left of our brains. We have singalongs and dances. Those dances are something; you should see