Meetings

2005 White House Conference on Aging
LCAO Listening Session
Wednesday, August 18, 2004, 2:00 p.m.

Policy Committee members present: Dorcas R. Hardy, Policy Committee Chair;
Robert Blancato, and Gail Gibson Hunt
WHCOA staff: Dr. Ann McGee, Executive Director, Sam Keeley, Nora Andrews, SueEllen Knowles, Moya Benoit Thompson and Remy Arnoff
AoA staff: Heather Harris

Comments of Lisa Gables, Executive Director
National Adult Day Services Association

Background

The National Adult Day Services Association is a 20-year old organization that provides its members with national advocacy, educational and networking opportunities, technical assistance, research and communication services. Adult Day Services are providers of community based care for frail elders as well as persons of all ages with multiple and special needs associated with Alzheimer’s disease, developmental disabilities, traumatic brain injury, mental illness, HIV/AIDS, vision and hearing impairments and more. NADSA was formerly a constituent unit of the National Council on the Aging, but is now an independent national organization representing adult day services.

Key Points:

The WHCOA should help with public awareness about the availability of adult day services as a viable option for long term care.

There is a lack of information and data about adult day services across the country.

The WHCOA should consider the aging of not just older persons, but the MRDD population as well.

There is a quality of care challenge because services are fragmented and each state sets its own standards.

Adult Day Care Services can prevent elder abuse in the home.

The WHCOA can help promote a message that we need to plan ahead for long term care needs of ourselves and our families, and not get caught off guard.

Summary of Comments:

Ms. Gables led her comments by stating the importance of public awareness about adult day services as a viable community-based option for long term care. She indicated that adult day care is an economic solution that has a visible, positive outcome in terms of people’s health and quality of life.

Stating that there has been no real research into this issue and no one place one can go to learn more, NADSA has also been working with CMS and ASPE and has convinced ASPE to do a research project that would do a nationwide (state by state) environmental scan of adult day care services. She indicated that NADSA is also closely following the progress of a demonstration project for medical adult day care services under the Medicare Modernization Act designed by the Centers for Medicare and Medicaid Services to test, in a medical adult day care setting, the provision of home health services to home health eligible individuals.

At the State level, there are serious fiscal issues with Medicaid, which causes some individuals into a crisis mode. When there are budget cuts, Medicaid services are often cut first, and they must fight this on a state-by-state level, and have had some successes and some failures.

NADSA wants to put on the table that Adult Day Services is a viable option but it is little known by most people. 60 to 70% of their providers do providing nursing home level medical care, including IV therapy and wound care. And their services are not just for older people; it is for those over the age of 18, most with chronic conditions. Ms. Gables expressed concern about the aging of the MRDD population and their needs as they continue to grow older. She urged the WHCOA to think about how we are going to care for this population.

Ms. Gables believes that the biggest problem is lack of public awareness from a government level as well as provider level. She urged the WHCOA to help highlight this issue from a national standpoint so that they could influence action and help them craft a message that adult day services are a viable option for long term care.

Questions from Policy Committee

Ms. Hardy: Tell us more about the ASPE demonstration project.

A: It will start in October, and is a one-year project. The deadline was last week for applications. Ruth Katz is the ASPE staffer who will be doing the policy synthesis of adult day services across the nation.

Ms. Gables pointed out that many individuals know a lot about home care but not about adult day care, and there exists a lot of difference between the two, therefore we need to craft a project that projects the right information. The MMA project is a three-year project (ABT Associates) that will be in the beginning/design phase in December/January with the RFP’s out in late spring or early summer.

Ms. Hardy: You have made a point about the difference between home care and adult day care. Do you see a point where they can come together?

A: Yes, Kentucky is an example in that it is a gatekeeper state. To receive adult day care services, you have to be referred by home care. South Carolina and Massachusetts also provide under Medicaid personal home care attendants that work with adult day care providers.

Ms. Hardy: It is clear some data is lacking. I have a view that to be in an adult day care situation, it is mostly those with severe chronic or medical conditions and often lower income.

A: What we have found is we are able to identify people just out of acute environments. We have found that the families have a difficult time dealing with this, and they are only able to adjust for a few weeks before they begin looking for other alternatives. Medicare does cover this for 30 days.

Ms. Gables went on to say that people (family members) are often caught off guard – for example, in the case of a stroke, which is unexpected. The White House Conference on Aging should address the issue of pre-planning – and really emphasize the need to plan ahead for life events of family members that can change the course of their own lives and job situations.

Ms. Hunt: It is great that ASPE is going to this one however in only one year it will be very difficult to show (the impact).

A: The purpose of the ASPE project is to do an environmental scan of what’s out there. Currently there is no data, no document. The purpose is to create a document to identify similarities and differences. It is a start.

Ms. Hunt: You mentioned public awareness – seems like you are in situation that assisted living was in – it is hard for me to see what the WHCOA can do to help with public awareness.

A: By public awareness, I mean profiling this issue through the Conference in some way.

Ms. Hunt: I think making CMS aware of it is a great start, they should know about it. The White House Conference on Aging can work to let government agencies know about it.

Ms. Hardy: How are adult day care services paid for if one is not eligible?
A: Private pay, VA, Block Grant funds, matching funds from local and counties, and in a few places long term care insurance. In 5-6 or 10 years if Medicare decides to pay for this, you will see an expansion of services. Senior centers will/should be developed and built with these services.

Mr. Blancato: I am assuming that the Conference will address quality of care issues. Are there any quality challenges?

Ms. Gables: The biggest problem we see is that the services are highly fragmented and each state sets its own standards. Therefore the quality standards vary significantly. And as another example, the VA has its own set of quality standards. Some states have no quality standards and some states do have higher standards. What we have done is take a look at all the states and we have set our bar higher. Should Medicare decide to add this as a benefit, there will be an accreditation process. It is my personal opinion that standards need to be beefed up some. ASPE’s study will look at this.

Mr. Blancato: I think it is a good suggestion that the WHCOA make a signature statement on urging planning for these types of situations. It is important that people plan ahead and know where to go (when crisis hits).

Ms. Hardy: Yes, don’t get caught off guard.

Ms. Gables. Yes, there are social and financial issues to consider – and how are we going to deal with the caregiver issues in the future?

Ms. Hunt: CMS has for 4 years had in the works a “Plan for Long Term Care” national campaign – ASPE has now taken this out of CMS and together they will run pilots in 4 states.

Mr. Blancato: A White House Conference on Aging does have the ability to put out the word – I think the Chair’s idea of redefining the verbiage of the aging field is a good one. We also need to lay out in public terms the options available, the quality issues, and the viability. This is something we could do and do it well.

Ms. Gables: I recently had the opportunity to speak internationally at a conference similar to the Renaissance weekend event. One of the key messages that came from it was “Can government keep its promise” I found that other countries take a different approach to caregiving and aging and the one issue that resonated with everyone is the issue of elder abuse, an issue that Bob knows much about. Adult Day care is a good preventer of elder abuse.