dress their nutritional needs with a daily lunch and an optional breakfast service. In addition to meeting the specific needs of participants delineated above, I believe our program has made valuable contributions to three other social concerns which confront this country. The first is the need to maintain and enhance the ability of family care givers to continue their roles. Second, is the desire by all of us to promote the elderly person's independent living as long as possible. Third, is the ability to use limited fiscal resources to reach as many individuals as possible. Let me expand on these three just a bit. First is maintaining and expanding the role of the family care giver. Family members provide 80 to 85 percent of the care given to our elderly. These care givers, many times, are retired spouses of the individuals who need assistance. More and more frequently, however, care givers are middle-aged wage earners who struggle to balance the demands of their jobs with the responsibility of caring for aging persons. All these care givers need the kind of support which adult day care can provide. For those retired spouses, adult day care can relieve the isolation and other stresses that may eventually impair the ability of that care giver to live independently. For employed care givers, the respite provided by adult day care can help them to continue their own growth and establish a financial base for their own retirement years. It also permits many of these individuals to contribute economically to the welfare of their parents. My second point is promoting independent living. Behind the phrase "promoting independent living" is the implicit intention of avoiding nursing home placement. Although I feel very strongly that there is a place for the nursing home in the overall continuity of care, I do share the value that there is no substitute for independent living if that individual can remain healthy and safe. I believe adult day care centers can provide this environment for many, many individuals. Day care can also help some elderly persons over the rough spots which might otherwise result in nursing home placement. We had an example of that in our own center not long ago. An 86-year-old woman who lost her husband, became depressed, confused, over-medicated, and eventually ended up in the hospital. She entered our day care program after six months of treatment and therapy, both in the hospital and in the community. Within six weeks, she was able to move into our retirement home, where she continues to function well. This was a case in which the nursing home staff worked with the day care staff to successfully avoid nursing home placement. We believe that this teamwork has helped most of our participants avoid or at least delay placement in nursing homes. My third issue is the efficient use of limited resources. We are all concerned about health care costs, and nursing home costs have especially captured public attention. The program at St. John's not only reduces the State and national burden of nursing home costs, because nursing home placement is avoided, but it also uses nursing home resources to reduce the cost of adult day care. At St. John's, our arrangement permits us to offer a broad range of health and social services, utilizing the expertise of specialists in nursing, dietetics, social work, and activities for $16 a day, including lunch. A participant who comes to our center five days a week for a full day pays $80 a week for these services. That totals a little more than $4,000 per year compared to $18,000 to $22,000 for nursing home care. In conclusion, allowing the elderly to maintain their independent life styles, reducing stress on the family members who care for them, and doing so in an economic manner is a challenge we hope many others will accept. Again, we appreciate this opportunity to share these ideas with you and thank you again for the support you have provided for this very important issue. Thank you. [The prepared statement of Mr. Peterson follows:] Statement of DONALD A. PETERSON Executive Vice President On behalf of The American Association of Homes for the Aging Chairman Melcher, members of the Special Committee on Aging, I am Donald A. Peterson, Executive Vice President of St. John's Lutheran Home in Billings, Montana. St. John's is a multi-service provider of independent retirement living, intermediate and skilled nursing care, respite care, Alzheimer's programs, information and referral services, and adult day care. I am here today representing the American Association of Homes for the Aging (AAHA), a national nonprofit association which represents more than 3,200 nonprofit providers of long term care, housing and community services for the elderly. On behalf of AAHA, I would like to thank the Committee for providing this opportunity to testify about this country's need for adult day care services. I would also like to thank you, Mr. Chairman, for the support you have given to the adult day care issue in the U.S. Senate. The introduction of S. 1839 is an important step in making this health care option available to additional numbers of Americans. As the National Institute for Adult Daycare (NIAD) has noted, the number of programs has risen from fewer than 12 in the early 1970's to nearly 1,400 today. That is certainly progress. I can tell you from my experience, and that of my AAHA colleagues, however, that the number of centers at the present time does not scratch the surface of day care needs presented by our elderly citizens and their adult children. Our I think my own program in Billings presents a good cross-section of the kinds of individuals who need this service. We have a total of 16 participants, who spend from one to five days per week at our center. current participants range in age from 65 to 92 years. Seven of these participants have some degree of dementia, sometimes combined with a medical condition. Eight of the participants have some kind of chronic health problem without dementia (i.e., heart or post-stroke problem). our oldest resident, a 92-year old woman, comes just for the company-she has outlived her oldest friends. A lot of our participants come for the socialization value, in fact. After all, your children, even when they are grown, are still your children, not your peers. Adult day care programs are designed to provide socialization for the participants at the same time And they address their health needs. In addition to medical monitoring and medication assistance, we provide psychosocial, recreational and other programs for our participants who have degenerative or chronic conditions. We also address their nutritional needs, with daily lunch and an optional breakfast service. In addition to meeting the specific needs of participants, I believe our program has made valuable contributions on three major societal issues: (1) the need to maintain and enhance the ability of family caregivers to continue their roles; (2) the desire of all of us to promote the elderly person's independent living as long as possible, and indefinitely if we can; and (3) the need to use limited fiscal resources to reach as many individuals as possible. Maintaining and Expanding the Role of Family Caregiver. Family members provide 80-85 percent of the care given to our elderly. These caregivers many times are retired spouses of the individuals who need assistance. More and more frequently, however, caregivers are middle-aged wage-earners who struggle to balance the demands of their jobs with the responsibility of caring for aging parents. All these caregivers need the kind of support which adult day care can provide. For those retired spouses, adult day care can relieve the isolation and other stresses that may eventually impair the ability of even the caregiver to live independently. For employed caregivers, the respite provided by adult day care can help these wage-earners continue their own growth and establish a financial base for their own retirement years. It also permits many of these individuals to contribute economically to the welfare of their parents. For all caregivers, adult day care cent can serve a teaching as well as a caring role. Both participants and caregivers can be instructed in new or alternative ways of meeting the elderly individual's needs. This educational effort can enhance the quality of the at-home care. Promoting Independent Living. Behind the phrase "promoting independent living" is the implicit purpose of "avoiding nursing home placement." As the director of an organization which contains what I believe is a very fine nursing home, I don't share the view of some that every nursing home is a dungeon to be avoided at all costs. But I do share the value that there is no substitute for independent living, if the individual can remain both healthy and safe. I believe adult day care centers can provide this environment for individuals who have help during the evening hours but who would be alone, and vulnerable, during the day. The incapacity of caregivers resulting from being over-burdened by caring for an aged person can truly deplete their physical re sources. Among the services noted in our book, Women Take Care, are adult day care, respite care, and home health care. As you have noted in your opening statement, Medicare does little to pay for those services now. It is focused exclusively on acute care. At the same time, although Medicaid allocates 40 percent of its nationwide budget to nursing home care, a couple must impoverish themselves to qualify for Medicaid coverage. Being considered, now, in conference is a critical bill that addresses spousal impoverishment. We hope that the conference will report out the most liberal support for the community spouse so that the community spouse is not impoverished for years as a result of needing to care for the aged one in need of skilled nursing care. Private insurance offers virtually no assistance at this time to Americans requiring extended home care and skilled nursing home care. In conclusion, we need national health policies that support families as they care for their incapacitated members. We need policies that are concerned for the well being of the caregiver as well as the person cared for. We need a Federal system of services for longterm care that will strengthen families who give care, not weaken them, that will nurture the caregiver, not exploit her. Adult day care programs would be a major resource, a major assistance to those caregivers as well as to the cared for. Therefore, the Older Women's League urges the expansion of both Medicare and Medicaid to cover respite, adult day care, and home health care, and we applaud you, sir, for the promotion of S. 1839. Thank you. [The prepared statement of Ms. Glasse follows:] |