By Thomas Goldsmith
Time spent at an adult day care center can make major life differences for older North Carolinians who have trouble staying at home alone, and for those who look after them.
For thousands of caregivers of an older person or someone with disabilities, such a center serves a place of safety and activities for the person who might otherwise sit home all day, unable to cook, drive or fully care for herself. Despite the help the service provides for participants and caregivers, adult day services are having a hard time staying open in North Carolina.
“The challenge in the adult services arena is that the reimbursement rates have not changed in years,” said Lee Covington, president of Williams Adult Day Center in Winston-Salem. “If we want to have nice facilities, and train and retain the best staff, our expenses go up every year.”
The state’s rates of $33 daily for adult day care and $40 for adult day health cover perhaps 50 to 60 percent of the cost of looking after program participants, industry representatives said.
Nationally, adult day care costs $70 daily on average.
Carole Grady, 65, of Raleigh, brings her mother, Rachael Mann, 87, to the Total Life Center adult day care on Departure Drive three days a week. Dressed to go out and with silver hair neatly in place, Mann elected on a recent Tuesday not to throw a basketball into a hoop with others. She sat instead in a common area where she was greeted by staff and friends.
“I have a caregiver for her three days a week at home,” said Grady, whose parents moved in with her after she became an empty nester. “This gives her an opportunity to get out. It’s a lot less expensive than in-home aides.”
Grady is able to continue her career as a full-time travel agent, knowing that Mann is safely looked after either at home or at the center, which is operated by the nonprofit Resources for Seniors. Across the state, about 5,000 people use such facilities.
What are adult day services?
Adult day care allows people to stay for eight or more hours a day, have meals, engage in activities, and enter into the friendly relationships that are one key to continuing health. Adult day health is a similar service for people with health problems.
However, adult day care and its close relative, adult day health, are typically nonprofits and maintain a low profile compared to the larger, more powerful residential long-term care industries. That’s meant that leaders in adult day services, called ADS, have fought for many years to have what they call unsustainable state reimbursements increased from levels imposed by law 12 years ago.
“The level of familiarity is probably pretty low,” Covington said. “People find out about it when they need it.”
Adult day centers accommodate people 18 and older, including some with intellectual disabilities, stroke survivors and people with dementia. For care providers, centers such as this one offer a release from the overwhelming stress of looking after a parent, a spouse or child who can no longer stay alone for long.
‘It was stunning’
In an email about the statutory rate for adult day care, the state Department of Health and Human Services said the service is an important part of meeting the needs of older North Carolinians, but not a sector for which the state should take full responsibility.
Mark Bumgarner, president of the NC Adult Day Services Association and executive director of Adult Life Programs in Hickory, recalled getting a “dismissive” response when he raised the rate issue with Dr. Mandy Cohen, secretary of the state Department and Health and Human Services.
“I met with her personally and her suggestion was that we engage in fundraising,” Bumgarner said during a phone interview. “The reality is that most of us are working as hard as we can, just to provide the services we have. We don’t have the infrastructure to do large amounts of fundraising.
“For a number of reasons, that was a very flip and uninformed response. It was stunning.”
Cohen’s office said that the exchange in 2017 concerned finding both public and private money to pay for the service.
“The reality is that budgets are limited and decisions have to be made within that context, which we understand is frustrating,” said an email from DHHS communications staff in response to questions about Bumgarner’s statement. “Our team works incredibly hard to maximize every dollar and resource across divisions to support a continuum of services that protect the health and safety along with the dignity and independence of aging North Carolinians.”
But that support appears to be falling short. Where DHHS once licensed more than 100 ADS centers across the state, about 80 operate today.
“There are many factors at work when facilities close, but some of those actors could be assisted through a better rate,” said Michael Boles, program director for the adult day services programs at Resources for Seniors in Wake County.
Adult day services are funded in part by Home and Community Care Block Grants — federal money dispensed by the state, but ultimately routed by county decision-makers to agencies offering help such as Meals on Wheels or in-home aides. ADS is the only such service that has had its rate set by statute instead of settling on a price with each county.
ADS allocations are dwarfed by the mega-millions that go into long-term care in assisted living and nursing homes, destinations that participation in an adult day program can delay or avoid altogether.
Dealing with dementia
DHHS officials say, and Boles agrees, that many older people need a range of settings offering specific levels of care.
“There is a time when an in-home is a perfect solution and there is a time when long-term care is a perfect solution,” he said.
About a third of Wake County ADS participants have some level of cognitive decline. Staff members say that the center provides not just what older people want, but also what anyone would want — a place to go, people to talk to, food, entertainment, a little exercise.
“We don’t go on field trips, so we bring the outside inside,” said Stella Ray, executive director of the center at Departure Drive in Northeast Raleigh.
This Total Life Center in North Raleigh is one of four in Wake County. The nonprofit agencies received extensive volunteer help, as a stream of special visitors shows up throughout any given month. They range from Cardinal Gibbons High School students to a pianist, special dancers, ukulele players, volunteers from Hope Church and a crew of singers from the Junior League.
“The Rotary Club is coming with Christmas presents for everyone,” Ray said.
In warmer weather, participants have cookouts and gardening to anticipate.
“Mostly they enjoy music and food,” Ray said. “They feel so safe.”
Caregivers can handle shopping, meet their own medical needs, or find time for respite while knowing the people they care for are in good hands, she said.
There’s a health room for people who are having physical problems and a quiet room for those who need a little time to settle down. Wake County’s four adult day services locations are staffed by two registered nurses and a licensed practical nurse. These professionals represent another level of protection for some of North Carolina’s most vulnerable citizens.
“A lot of times we can catch when people are getting sick, even before the family does,” said Cara Henderson, health coordinator at Departure Drive.
How we reported this story:
- Regular attendance at monthly statewide meeting on aging and disability matters
- Checks with sources on story tip that touches individuals, nonprofit agencies, businesses and government divisions
- Consultation with past, current leaders of relevant professional associations
- Information request from government agency, based on tips drawn from reporting
- Visit to a real-world facility, with interviews and photos to test story premise
- Renewed a request to government agency in pursuit of clarity and additional information