United States Senate

Office of Senator John Melcher

Special Committee on Aging

Senate Office Building

Washington, D. C. 20510

Item 4

August 31, 1988

It is a pleasure to have the opportunity to supply you and Senator Grassley with a bit more detail on a few of the families in our adult day health care center. Five families were chosen to further illustrate the cost of day care, sources of payment and to compare these costs to the cost of an intermediate care nursing home bed in the Northern Virginia area.

Each of these older people is limited mentally and/or physically to the degree that they would be qualified to receive state medicaid funds for intermediate care in a nursing home. Yet in each case, the spouse or child of this person has chosen to care for them at home and to send them to day care during the day.

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Mrs. A. a 75 year old woman who is memory impaired and confused lives with her only daughter and her son-in-law. Both caregivers work full time. Mrs. A cannot be left home alone safely, so day care provides the care she requires while they work.

Mrs. A is ambulatory but losing bladder control.

He

Unfortunately, Mr. B. suffered 2 strokes in his sixties.
is now 75 years old, very weak on one side but able to walk.
His left arm is useless to him and his speech is severely
limited. His wife helps him with bathing, dressing and many
other activities. They live alone in their own home and
although they love each other very much, Mrs. B. finds
constant care of Mr. B. mentally and physically exhausting.
Without the care provided by the day care center during the
day, Mrs. B. says she might have to consider nursing home
placement. She fears that might eventually "make her a
pauper" and create a sad situation emotionally for herself
and her husband.

Mrs. C. lives with her daughter, son-in-law, and her teenage
grandson. She is frail in several ways, has some chronic
illnesses and exhibits obsessive/compulsive behaviors.
Although she has fallen several times, fracturing bones,
she can still walk and comes to the center 5 days a week on our
bus. This allows her daughter to run a child care business in
her home and care for her mother nights and weekends.

Although wheelchair-bound, mentally confused, and incontinent,
Mrs. D. who is 96 years old, still lives with her son and
daughter in law. Her income is very low and medicaid could
have paid for her care in a nursing home for years if not for
a combination of family caregiving and day care.

Mr. E. is only 68 years old but suffered a large stroke 5 years
ago leaving him paralyzed on his left side. His judgment is
not always on target but he is very alert and oriented. He
says he would "rather be dead than in a nursing home" and he
realizes he would be on medicaid and his wife would be
"broke."

Instead, he hires a companion to care for him at home 2 days a week, comes to the center 3 days a week, and his wife cares for him weekends, on her days off. He is wheeled in his chair up the wheelchair lift of the center bus, is assisted by the staff at the center with personal needs and is given medications, therapy, and health care monitoring by the nurse.

Nationally, the daily fee for day care ranges between $20-$50/day. The higher range becomes necessary when a center is privately run and is not supplemented by local tax dollars as we are here in Fairfax County. Our actual cost to care for each participant is $38/day in 1988, but we do not have to pay rent or utilities.

The Title XX program has an option to reimburse for adult day care. The decision rests with each locale as to whether they will co-pay along with some federal funds so that program varies quite a bit.

Lastly, to compare the cost of day care to nursing home care, one must look at that difference in each geographic area. Nursing home costs are high in the Northern Virginia area, as they often seem to be in more urbanized areas.

The base rate for an intermediate care nursing home bed in this area is approximately $75-$82 per day or $27,000 to $30,000 annually. For the private pay resident there are often many "add-on" charges for extra supplies, such as adult diapers, or extra tasks, such as hand-feeding.

Medicaid also reimburses nursing homes for eligible intermediate care residents. The rate is individual and cost-based, but an approximate range in this area is $65-$75 per day. of course nursing homes must be reimbursed 365 days a year. On the other hand, if a person can stay at home using 5 day a week day care service, reimbursement is needed for only about 256 days per year.

I hope these case examples and these figures shed some more light on the costs and reasons for day care as opposed to nursing home Please thank Senator Grassley, Senator Melcher and the other members of the Committee on Aging for their support.

care.

Sincerely,

Day Larmer

Kay Larmer

87-615 (128)

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