Town Square

On Deadline: Does it matter whether 'senior day health' programs survive?

Original post made by Jay Thorwaldson, editor emeritus, on Jun 29, 2011

One could easily rephrase the question above: How much do seniors matter to society, our communities, our state or nation?

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Posted by Marie
a resident of Midtown
on Jun 29, 2011 at 9:19 pm

Marie is a registered user.

As a retired person, who wants to age in place, I am supportive of anything that will help me do it. However, per the website below, the average cost per day is $64.

Web Link

That seems really high and my guess is that the Palo Alto program is probably "above average." Avenidas does not state what the full unsubsidized charge is on its website that I could easily find. I also don't know what the state pays but I vaguely remember reading an article that it was in that range. If someone was in adult day care 5 days a week, 22 days a month, that would be over $1,400 a month which is more than low cost 24/7 hour living facilities (not nursing homes). Full price at Chai House in San Jose for a one bedroom is $1,211 per month. For $224 more, you get a monthly meal plan. The subsidized rate is less. Why is senior day care so expensive?

Sadly, it doesn't make sense for the state to pay more for adult day care than for 24/7
care. I have a relative who has a parent in an altzheimer unit, albeit in Stockton, for $1,200 a month, paid for by his social security and SSI. Sadly, in the kind of budget crisis we are in, unless they can reduce the cost of adult day care, it is cheaper to use those live-in facilities. My guess is senior day care programs pay their workers and administrators more than low cost assisted living centers and/or perhaps have higher administrative expenses since they are not 24/7. It is a conundrum.

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Posted by Too bad
a resident of Greater Miranda
on Jun 30, 2011 at 11:39 am

Marie: Extremely well said. I love Avenidas, but the reality is always about "bang for the buck", isn't it? And, we have to face reality, in a shrinking economy, there simply isn't as much buck to give a bang with.

However, how about private donations to help keep these places going? There are still a few folks with money left in the area, maybe there would be some kind donors willing to help out, as long as the costs could be pared down. What on earth is costing so much, I wonder? Seems worth a look

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Posted by Avenidas
a resident of Downtown North
on Jun 30, 2011 at 12:17 pm

It is great to see people talking about such an important issue, but some misperceptions should be clarified. People are mixing apples and oranges in their discussion here. There are two models of care: the social model, which is simply adult day care. Then there is the medical model, Adult Day Health Care, and that is the model that Avenidas Rose Kleiner Senior Day Health Center (SDHC) in Mountain View follows.

SDHC is a licensed Medi-Cal certified health facility that treats the health and supportive needs of older adults with multiple, chronic conditions in a safe, homelike day setting. The goal of SDHC is to prevent or delay placement into nursing homes or other more expensive care settings. This is done by improving and preserving each individual's physical and mental health, and improving their quality of life. Older adults with chronic conditions are able to successfully live in the community while a benefit for the caregiver is regular respite from 24-hour caregiving responsibility. SDHC provides many health and social services under one roof for one set daily fee. Persons attending SDHC are pre-approved by the Medi-Cal field office (if a Medi-Cal beneficiary). Non Medi-Cal participants pay out-of-pocket. The Avenidas Rose Kleiner Senior Day Health program uses a sliding scale for private pay participants, which ranges from $76. 27 to $125 per day.

SDHC participants attend, on average, 3 days per week. Many services and activities are offered based on a thorough assessment and plan of care. Services provided on an individual basis include nursing supervision and assistance, medication monitoring, physical therapy, occupational therapy, speech therapy, and social work. Assistance with daily tasks such as eating and walking are provided by trained program assistants. Group activities provide companionship and social stimulation and are designed with the participants level of ability and interests in mind. A noon meal, transportation to and from the center, caregiver support groups, community outreach and education and other services are also provided.

Generally, by having their frail and elderly loved ones attend Avenidas Rose Kleiner Senior Day Health Center, families can keep them out of nursing homes longer. These folks are not candidates for independent or assisted living—they would need to go to skilled nursing facilities, which are very costly.

Avenidas doesn't believe it is a good fiscal decision to cut Medi-Cal funds for this type of care because institutionalizing chronically ill older adults is much more costly and puts a heavier burden on the healthcare system.

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Posted by Marie
a resident of Midtown
on Jul 1, 2011 at 6:59 pm

Marie is a registered user.

As an alternative to nursing homes, Avenidas' program makes sense. Does this mean this program can give medicines and do testing, like blood glucose tests, as nursing homes can?

At $125 a day (apparently full cost), that means approximately $15 an hour, which is probably less than most, but not all, private home health aides. I realize this is not apples to oranges as Avenidas provides a lot of services that a home health aide cannot, but the reverse is true as well. From the perspective of providing a break for caregivers, however, the two kinds of services are the same.

Aging in place is not a simple path but one I hope can be cost effective. Often it isn't. To end up in a nursing home when living at home is possible with extra resources is a tragedy.

I have mixed feelings about the medicaid part. If only those recipients who were eligible for a medicaid financed skilled nursing facilities qualified for medicaid assistance in senior adult day care, then I support it.

However, compared to assisted living facilities, it does not make sense. What would impress me more is if there was a social program available at a much lower cost than home health aides, for those who aren't ready for skilled nursing but whose caretakers still need a break.

My understanding from the website is that Avenidas is a 501(c)(3) nonprofit, which does have an endowment and does receive significant funds from private donations. However, my best guess is that it will be quite difficult to make up the medicaid funding from private donations alone. I hope someone is actually tracking whether the severe cuts in senior daycare does increase medicaid spending due to an increased number of people going to nursing homes. That would certainly be a great argument to get funding restored.