Adult day centers seem to have made it into the political debate in Washington, though not in a good way. In his nasty weekend back-and-forth with President Trump, Senator Bob Corker (R-TN) suggested the White House has become an “adult care center” and wondered if the staff had “missed a shift” when Trump launched his Sunday Twitter storm. Yesterday, Rep Diane Black (R-TN)—who wants to run for governor—replied that the Senate “is an adult day care center” that can’t get anything done.
Leaving aside this mature level of political discourse, the name-calling does raise an important question: What are adult day centers and how do they work?
Adult day centers can be an important service to frail seniors and other people with disabilities who are living at home. They provide companionship, social support, and sometimes therapy and medical services. For people who live alone or even with a caregiver, adult day programs are an opportunity to get out of the house and spend time with others. Many, though not all, provide transportation to and from their centers.
Adult day programs not only benefit frail elders and younger people with disabilities, they can provide important respite for family caregivers. Knowing that a loved is in a safe place where they’ll get a meal , companionship, and mental and physical stimulation can ease the burden on family members and give them much-needed time for themselves.
There are two main forms of adult day programs. The social model provides meals, activities, and sometimes health-related services. The medical model provides additional health and therapy services, as well as social activities and meals. Specialized programs may care only for those with dementia or developmental disabilities.
About 80 percent have a nurse—either an RN or a LPN– on staff. About half have a physical, occupational, or speech therapist, according to the National Adult Day Services Assn. The group estimates that there were nearly 5,700 sites in 2014. The federal Department of Health and Human Services (HHS) reported about 273,000 participants in 2012. There are likely far more today.
Some adult day programs may offer half-day as well as full-day services. They usually operate only on weekdays. Some, like the Program of All-Inclusive Care for the Elderly (PACE) program may provide comprehensive medical services.
What do they cost? The Genworth cost of care survey estimates the average daily cost of adult day is $70 for a 6-8 hour day. That’s about half the cost of a home health aide for the same period of time. However, costs vary widely among the states. In Alaska, the average cost of adult day is $168. In Buffalo, NY, it is $49.
Will Medicaid or Medicare pay? Medicare will not pay for adult day. Medicaid funding depends on state law. Medicaid will pay something in nearly every state, though the amount is often limited and participants may face long waiting lists. Many adult programs will not accept Medicaid and only take those who can pay out-of-pocket. Long-term care insurance may cover adult day programs, but read your policy to be sure.
Are adult day programs licensed? They are regulated by the states, and rules and standards vary widely. In 2014, HHS reported that while all states impose some regulation on adult day programs, only about half required them to be licensed and another 10 required certification. Some states do annual inspections. Other may visit only every 3-5 years. Some may allow staff to administer medications, others may only allow medical model staff to do so.
This week’s snarky remarks about Trump, the White House, and the Senate may have an unintended benefit: They may raise the profile of adult day programs. That’s a good thing since while adult day remains largely unknown, it can provide an important service to help frail seniors or younger people with disabilities remain at home.
Full disclosure: I am an unpaid board member of the Jewish Council for the Aging of Greater Washington, which operates both medical and social model adult day programs.