STATEMENT OF KAY LARMER, CHAIRPERSON, NATIONAL INSTITUTE ON ADULT DAYCARE, NATIONAL COUNCIL ON THE AGING

Ms. LARMER. Senator Melcher and committee members, I am Kay Larmer, coordinator of Adult Day Health Care Programs for Fairfax County and also Chairperson of the National Institute on Adult Daycare, a membership unit of the National Council on Aging.

The National Council on Aging, founded in 1950, is a national, non-profit organization. Its membership includes individuals, voluntary agencies, and associations, business organizations, and labor unions united by commitment to the principle that the nation's older people are entitled to lives of dignity, security, physical, mental, and social well being, and to full participation in society. The National Institute on Adult Day Care is the only organization composed of professionals in the field working to develop and expand the adult day care field, to advocate for those who rely on adult day care services for daily and continuing support, and for those working to ensure that adult day care is of the highest quality, based on solid standards of excellence and available throughout the nation.

I am very pleased to be here today and have the opportunity to testify on behalf of this service and its benefits to older people and their families.

You have all received copies of my testimony. In fact, most of what I have said in my testimony has been eloquently said by the Senators and people that came before me.

During the past 10 years, adult day health care has developed to meet the needs of the ever-increasing frail and impaired population in our country. It provides a variety of services and activities that enable impaired adults to remain in their homes and communities.

As the term implies, adult day health care is a program of care during the day in a protective group setting. It is an innovative and effective way to organize and blend traditional health and social services for impaired adults.

Although adult day care is not a new concept, it is still not an integral part of the long-term care system in many areas. It was first introduced in the 1960's, but it has been very slow to develop, largely due to the lack of stable funding sources.

In 1973, there were only 15 programs. Today, however, there are 1,400 serving approximately 66,234 persons daily. This growth has been largely a grass roots effort, developing without any national initiative or coordinated funding source. In fact, it has occurred in spite of a public policy that long has favored institutional care.

Programs have sprung up throughout the country under the auspices of a variety of sponsoring organizations, both public and private. The majority are non-profit. They are located in churches, hospitals, multi-purpose senior centers, elderly housing projects, nursing homes, and homes for the aged.

The average per diem cost for adult day care is $27. Earlier, it was mentioned that it is $31, and that is if you include the in-kind

services that most programs have. Still, it is much less than the cost of other forms of long-term care.

At present, most programs rely on multiple funding sources which include Title XIX, Medicaid, and Title XX of the Social Security Act of the Older Americans Act, Title III, client fees, foundations, and philanthropic support. A few receive reimbursement through private insurance carriers, and, in some instances, the Veterans' Administration is reimbursing veterans for this service. At present, there is little local funding from counties for adult day health care, and what funding exists is mostly in kind.

Most adult day care programs are staffed by a multi-disciplinary team, as you have heard from testimony before mine.

Though adult day health care programs are group programs, they are also tailored to meet each participant's need and preference. Adult day care offers an individual plan of care, based on a person's functional assessment. Each participant is provided the opportunity to socialize and participate in health, social, recreational, and therapeutic activities that maximize his abilities and independ

ence.

A diagnosis is not looked at with a participant when they come into the center, but we look at how they function and what we can do with what functioning level they have.

Probably the most important aspect for helping the individual is the atmosphere of expectation and hope. It consists of respect for the individual's latent strengths and the belief that some improvement is possible and the provision of the opportunity to try.

Those most likely to benefit from participation in adult day care programs are persons who would otherwise be substantially homebound or institutionalized. Recent State evaluation reports document these benefits. Adult day care assists the participant, his family care giver, and is a cost effective and efficient method of health care delivery, as you talked about earlier.

Adult day care restores and rehabilitates someone to their highest level of functioning. Every center can testify to the small miracles that occur such as the former stroke patient who learns to walk again through regular health monitoring, through nursing care, personal care, and enjoyment found with just being with friends.

Others are maintained at their highest level of functioning, thus preventing further decline and debilitation. In California, recent studies documented this and found that 87 to 96 percent maintained or improved in functioning.

This is saying something when you consider the average age of adult day center participants ranges from 72 to 76.

For the care giver, as Lou Glasse talked so eloquently about, the benefits of adult day care have become increasingly recognized. Families provide 80 percent of all health care for the elderly, and I don't think this is stressed enough. It really is families that are providing the health care in our country today.

Business surveys are identifying that up to 35 percent of employees are providing some form of care giving to their older family members. It is not surprising in this country which has a majority of two career families that research is showing that care giver

burnout is the most significant factor in nursing home placements, not the physical and health status of the older person.

At our centers, we find that we can continue to provide for very impaired people. It is generally when the family burnout is to the point where they can no longer continue to care for someone at home that the decision to place them in a nursing home occurs.

Family resources are not unending. Fatigue, lack of personal time, mobility of family members, financial costs, and the need or desire of family care givers to seek employment lead to stress and eventual breakdown in the family's efforts.

Adult day care is a valuable service as it provides respite to the care givers and relieves stress, enables them to continue to work, and helps employee productivity.

For the government it helps. By utilizing the benefits of a group setting, adult day health care costs less than the one to one provision of home health care and other institutional care services.

For example, under the Medicaid waiver program administered by the State of South Carolina, an adult day care medical package including a physical therapy service costs $40 a day as compared to a $60 charge for only the physical therapy services in the home. The center package also includes a full day of programs, meals, nursing care as needed, personal care services including bathing, recreation, and transportation.

Evaluation reports from other States such as Hawaii, New Jersey, and Massachusetts also indicate State satisfaction with adult day care's costs and their effectiveness.

At On Lok Senior Health Services in California, it was found that the use of adult day care was a vital component in the reduction of hospitalization. The monitoring and supervision of health status at the adult day health care center enables On Lok to prevent small health problems from becoming major problems needing hospitalization.

The hospitalization rate for On Lok's elderly persons certified for nursing home care is .7 percent of enrollment days, less than onethird that expected for this population and even lower than that for the general 65 and over population which is 1.1 percent.

Remember, these people were certified for nursing home care. Senators, NIAD and ÑCOA need your help. If we are to continue to grow and expand to meet the changing health needs of this ever growing elderly population, we need Federal legislation. NIAD believes Medicare funding as proposed in S. 1839 is required for the following reasons:

Medicare coverage for adult day health care will make it accessible to those low and middle income persons who do not meet the income eligibility requirements for Medicaid or social services block grants but cannot afford to pay for these services. It also will help prevent the older person from becoming impoverished before he or she becomes eligible for care, as you mentioned earlier, Senator.

Medicare is a trend setter for private health insurance coverage. Medicare coverage will point the way toward inclusion of adult day health care in long-term care policies.

Currently, we do have three insurance companies who do include us in their package.

Medicare funding will result in the development of national certification standards and a method of quality assurance. Although NIAD and NCOA have developed national standards, they are generic and voluntary. It would be helpful to the field to ensure that centers provide quality programs through a national certification

process.

NIAD and NCOA would be happy to work with HCFA not only in developing standards for certification but also for procedures and training for State employees.

Medicare reimbursement would also increase center resources, thus enabling those centers who wish to qualify for certification to add additional services if needed.

In my opinion, we have about 50 to 65 percent of the persons currently enrolled in adult day care who would be eligible under the intermediate care or skilled care criteria for nursing home care.

Senators, adult day health care has had over 10 years of experience. It exists in every State. The fact that four bills in Congress include adult day care means there is growing interest and recognition of the value of this service.

NCOA/NIAD believes the time for Federal legislation is now. We do not need further research, studies, or demonstrations. Financially, we cannot wait. Clearly, the present system is insufficient, inequitable, and bankrupts our Nation's frail and impaired population.

Thank you.

[The prepared statement of Ms. Larmer follows:]

Testimony

of

The National Council on the Aging. Inc.

and

The National Institute on Adult Daycare

Before The

Special Committee on Aging

United States Senate

April 18. 1988

Presentation to

Senate Special Committee on Aging

Monday, April 18. 1988

Senator Melcher, Honorable Committee Members. I am Kay

Larmer. Coordinator for Fairfax County's Adult Day Health Care Centers and past

Chairperson of the

National Institute on Adult Daycare (NIAD). a membership unit of the National Council on the Aging. Inc. (NCOA). the National Council on the Aging. Inc.. founded in 1950. i- national nonprofit

commitment

A

anization.

to the principle

Its membership includes individuals, voluntary agencies and associations, business organizations and labor unions united by a that the nation's older people are entitled to lives of dignity. security. physical. mental and social well-being. and to full participation in society.

The National Institute on Adult Day care is the only organization composed of professionals in the field working to develop and expand the adult daycare field. to advocate for those who rely on adult daycare for daily and continuing support and care. and for those working to ensure that adult daycare is of the highest quality, based on solid standards of excellence and available throughout the nation.