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By Thomas Goldsmith
When Jesse Casterlow was growing up near Rich Square in Northampton County, in the 1950s, people in the northeastern North Carolina community often met to enjoy music at a place that had a small jukebox.
Or folks would get together at a relative’s house because Grandma wanted to see the kids dance.
These days Casterlow, 71, gathers with a group of friends and acquaintances at a licensed adult day care center, with professional staff and services that help members of low-income, frail and vulnerable populations to stay healthy and sleep better , in their own homes, at night.
“I worked until seven or eight years ago,” said Casterlow said, sitting with friends recently at Southeastern Healthcare adult day care near WakeMed in Raleigh. “Then I started having problems with my eyesight and I couldn’t really function.”
Though popular with older people and their caregivers, North Carolina’s supply of adult day services, or ADS, is declining in number, in part because of a disparity in state reimbursement policy, supporters say.
Other services for older people and those with disabilities, chiefly paid for through North Carolina’s home and community block grant, can negotiate prices according to local markets. Those services include Meals-On-Wheels, in-home care and senior centers.
The rate can be adjusted by the General Assembly, or by the state’s social services commission, which makes rules for public assistance. But adult day care has had the same rate for more than a decade.
“We are mission-driven,” said Mark Bumgarner, executive director Adult Life Programs in Hickory, Conover and Maiden, noting that most centers are nonprofit.
“We can’t continue to sustain that without a rate increase. We may have to decide that we can’t continue to provide services,” he said.
For more than a decade, the state has paid about $33 daily per client for adult day care and about $40 for adult day health care at a center that employs a registered nurse. The NC Adult Day Services Association recently made a pitch to state lawmakers to change the rule on reimbursement methods, a cumbersome process that can take a year to 18 months.
Most of the money for adult day care — some centers are private — comes from the state’s federally mandated Home and Community Care Block Grants (HCCBG). That pot of about $33 million has to cover services from Meals on Wheels to in-home care, and many more, across 100 counties.
The number of centers has dropped from about 125 to 85 since the rate was last capped in 2007, something that hasn’t happened to other HCCB grant agencies. Fifty counties have no adult day services.
Association director Teresa Johnson Troup says legislators worry that increasing the cost per client will mean fewer people may get help under a limited allocation.
“Our response is, they are going to serve fewer people because you’re going to have centers closing,” Troup said.
Service can save state money
Pitching their service to the legislature’s Subcommittee on Aging, members made the point that clients of adult day care centers are often able to stay out of the more expensive long-term care centers, such as assisted living communities and nursing homes. About 50 percent of adult day clients have some form of dementia.
“For many caregivers, it’s the only way to can keep their loved one at home,” Bumgarner said.[sponsor]
“And people who are caregivers are one-third more likely to have health issues of their own. The other side of it is we are actually helping the folks we serve create their own social network. Researchers have found that seniors that are connected in their communities actually age better.”
Director Joyce Harper offered a tour of the Southeastern Healthcare center, which includes adult day care; adult day health, with additional medical services; and the recently introduced overnight respite, where cozy bedrooms await people whose caregivers need a break for one or more nights.
“We ask them to bring their own personal belongings,” said Lateefah Irving, healthcare administrator. “We try to make it as homey as possible.”
“If you have good balance”
For Cora Hunter, 86, the center serves not only as a place to make and meet friends but also as a center to her day.
“It doesn’t take me long to know people,” Hunter said. “It makes me feel, too, like I’ve been to work.”
Southeastern staff kept 35 residents busy on a recent Wednesday. Barbara Newkirk Young was urging them to shake it to James Roberson’s inspirational-soul hit “Everybody Dance.”
Keeping up mobility will make it more likely that clients can withstand the devastating falls that plague older people, Young said. “If you have good balance, when you fall, you might be able to catch yourself.”
Clients of the center typically show up in the morning and leave by about mid-afternoon, returning to the care of relatives and others, people whose charge it is to take care of aging adults or people with disabilities who can’t make it through the day alone.
Caregivers who go to work can have peace of mind and a form of respite because they know that that the person they drop off is not only safe but engaged in activities instead of just sitting around watching television.
After celebrating its quarter-century anniversary last year, Southeastern has become a part of local tradition, an echo of the past gatherings that clients remember.
“My grandmother used to go here a long time ago,” said Deborah Alston, 58. “It gave me an opportunity to get out of the house. I call it my activity center.”