In a move that shocked many in the elder care community, California has ended funding for its adult day care program. The question now is what will happen to the nearly 5,000 others that operate throughout the country.
California’s $169 million program serves about 35,000 low-income seniors and other adults with disabilities. The program will end in January when state Medi-Cal funding (the state’s version of Medicaid) is shut off for 300 adult day health centers around the state.
Adult day provides socialization, exercise, mental stimulation, assistance with activities of daily living, and often meals and health monitoring. Many also provide transportation from home to the care center and back. Fees usually run around $70 per day and while some adult day centers do serve a private pay population, many rely on Medicaid funding to make ends meet.
In recent days, California governor Jerry Brown has proposed an alternative. He’d pay the state’s Medicaid managed care insurers an additional $60-per-patient per-month to assess day care participants’ needs and help develop alternatives. However, fewer than one-in-five adult day attendees currently participate in managed care programs and advocates question whether alternative care settings will be accessible for many of them.
Adult day has had strong support from the aging community who see benefits both to recipients of the services and their family caregivers.
One key benefit is the respite that adult day provides caregivers. A long-running research project by Steven Zarit and colleagues at Penn State, as well as other studies, support that claim. They found that caregivers have less stress and depression for as long as a year after their loved ones begin using adult day services.
I certainly found that to be true in the interviews I did for my book, Caring for Our Parents. I don’t know what caregivers like May Barrett, who was caring for her husband Walt who suffered from both Parkinson’s and dementia, would have done without adult day. Having a few days a week where she could take a break while knowing Walt was well cared for was critical to her own health.
In addition, caregivers report that relatives with dementia seem more alert and have fewer behavior problems after spending the day at a center. This, in turn, may be one reason why caregivers report lower levels of their own stress.
Advocates also argue that participating in adult day programs can delay the need for nursing home care and allow people to stay at home longer. Importantly at a time of state fiscal distress, they say this saves states money since the cost of adult day is less than one-third of the cost of a stay in a nursing facility.
However, research support for this claim is inconclusive. Zarit, for example, reports that people who use adult day do remain home longer when daughters are their primary caregivers. However, when a wife is the primary caregiver, use of adult day may accelerate a move to a nursing home.
Another important question, also not well researched, is whether people to attend adult day are less likely to be hospitalized than those who do not, and if they have better overall health outcomes.
For a nice review of both the benefits and unanswered questions about adult day, take a look a this report by the Metlife Mature Market Institute.
In an era of growing cuts in public support for long-term care for frail seniors and adults with disabilities, government is going to be making some very tough choices about which programs to fund and which to cut. I think adult day is a keeper, but advocates will need stronger evidence of its economic benefits. If not, given that California often leads change, public funding for these adult day is in extreme danger.