Adult Day Care Centers in Connecticut (2024)

You asked about adult day care center programs for senior citizens. You particularly want to know how many there are in Connecticut, where they are located, and what their funding sources are (public, private, or both).

SUMMARY

"Adult day care centers," (also known as "adult day centers," "adult day health centers," or "senior day care centers") are one alternative for the elderly to avoid or delay entering a nursing home. Most attendees need some supervision or medical services and are able to travel to the center during the day, but have family members who care for them at night and on weekends. Daily fees range from about $40 to $80.

The state does not license adult day care centers. But in order to receive per-patient fees for their qualifying clients under the state's Home Care Program, they must meet the Connecticut Association of Adult Day Centers standards for certification, developed in cooperation with the Department of Social Services (DSS). There are currently 68 certified centers operating in the state in 47 towns, including the four largest cities (Hartford, Bridgeport, New Haven, and Waterbury).

There are two basic types of programs that adult day care centers can have: the "social model" and the "medical model." The social model serves people who need supervision and activities to reduce social isolation, but not extensive personal care and medical monitoring. The medical model also provides nursing, personal care, and other medical services. Only 12 out of the 68 centers follow a social model; the rest are medical.

The centers are funded by a mixture of public and private funds. Daily patient fees are the main source of funding. These can be paid privately by the individuals or by the state-funded or Medicaid portions of the Connecticut Home Care Program (CHCPE) for those who qualify financially. There is no state funding for starting up adult day care centers, but there is a small state allocation for Alzheimer's services at day care centers. Various federal funds under the Older Americans Act are distributed through the Area Agencies on Aging. Other potential sources include Department of Agriculture funds for nutrition and federal funds for transportation. Some centers receive funding from charitable organizations and foundations.

ADULT DAY CARE CENTERS PROGRAMS

"Adult day care centers," are one of several ways that elderly individuals can avoid or delay entering a nursing home. They exist in Connecticut and all other states. Most centers serve about 20 to 30 people. They are most useful for people who need some supervision or medical services and are able to travel to the center during the day, but who have family members available to care for them at night and on weekends. The centers can take one of two forms. They can follow either a medical model that provides some medical services and more hands on care, such as help with bathing, or a social model that provides only supervision and a program of social activities. Individuals can attend these centers from one to five days a week as needed.

The centers are not licensed by the state. Instead, they are "certified" through a process developed by the Connecticut Association of Adult Day Care Centers together with the DSS. A center could operate without this certification if all its clients were private pay, but to qualify for DSS payments on behalf of clients, they must meet the association's standards. Most, but not all, certified centers are members of the association. The association also certifies nonmembers. Most of the centers are nonprofit, but there are some for-profit centers. (OLR Report 96-R-1082, which we have enclosed, provides details on the certification process and DSS draft regulations, which include minimum standards for the physical space, personnel, a minimum direct care staff/patient ratio of 1:7, record-keeping and other requirements.)

Adult day care centers figure prominently in the state plan on aging. One of the goals in the plan is to provide day care services to a minimum of 1,000 Alzheimer's patients a year, at least 5% of whom will remain in the community for six months or more following the initial receipt of service.

NUMBERS AND LOCATION OF ADULT DAY CARE CENTERS

We have enclosed the DSS list of 72 centers that were certified between 1997 and 1999. Four have since closed, which leaves 68 still operating. There may be a few others that do not receive fees from the state. The centers on the list are located in 47 towns: Bloomfield, Branford, Bridgeport, Bristol, Brookfield, Canaan, Columbia, Danbury, East Hartford, Enfield, Fairfield, Farmington, Greenwich, Hamden, Hartford, Madison, Meriden, Middlebury, Middletown, Milford, Moodus, New Britain, New Canaan, New Haven, Norwalk, Norwich, Oakville, Plainville, Seymour, Shelton, Simsbury, Southington, Stamford, Stratford, Suffield, Thomaston, Torrington, Trumbull, Vernon, Wallingford, Waterbury, West Avon, West Hartford, West Haven, Wethersfield, Windsor, and Woodbridge. Some towns have more than one center.

FUNDING

Connecticut Home Care Program for Elders (CHCPE)

DSS is authorized to pay adult day care centers as an alternative to home care for qualifying individuals. CHCPE provides home health and other community-based services to individuals age 65 or older who meet financial criteria and have difficulty with the activities of daily living. The program has two components: (1) a "Medicaid waiver" portion, funded by Medicaid (which uses matching state and federal funds to pay medical bills for the very poor) and (2) a state-funded portion, which uses exclusively state money to pay for services to those who have more assets than Medicaid allows or who otherwise do not meet Medicaid requirements.

Medicaid Waiver. States can receive federal waivers from normal federal Medicaid rules to provide home and community-based services to recipients who meet the criteria for institutional long-term care services. This waiver, known as a section 2176 or a section 1915(c) waiver, was designed to correct a bias toward expensive institutional care in Medicaid services for chronically ill people, by instead allowing them to receive less costly at-home or community-based care. Initial waivers are approved for three years by the federal Health Care Financing Administration and renewable for five years.

States receive federal reimbursem*nt for half of the Medicaid waiver services to qualifying individuals. Income limits are $1,500 a month. A single person can have only $1,600 in assets. A couple who both receive services can have only $3,200 in assets. If only one person in the couple receives services, combined assets can be $17,992 or in some cases a higher amount that results from a special DSS assessment of spousal assets.

State-Funded. The state-funded home care component has somewhat more liberal eligibility requirements. It has the same $1,500 monthly income limit. But asset limits are higher: $16,392 for a single person and $24,588 for a couple, regardless of whether one or both are receiving services.

Rates and Payment Mechanisms. CHCPE pays for adult day care at the rate of $49.01 a day per person for the medical model and $45.95 for the social model. This rate is intended to also cover transportation to and from the center. The payments for home care and adult day care services are funneled from DSS through its access agencies, which do screening and assessments and contract for the services with the providers. These access agencies, which bid for contracts with DSS, include two of the five Area Agencies for Aging and, in other areas, Connecticut Community Care, Inc. The case manager at the access agency, who looks at all the client's circ*mstances, makes the recommendation for adult day care instead of at-home services.

State-funded Alzheimer's Respite Program

The state started a program in 1998 that provides respite care for families caring for people with Alzheimer's or related disorders. To qualify, the patients must meet certain income and asset limits. The program provides up to $3,500 worth of care annually. The care can take place in the individual's home, a nursing home, or an adult day care center. DSS runs the program in cooperation with the Alzheimer's Association and the Area Agencies on Aging.

Other Funding

Other than the above reimbursem*nt for patient fees, the only direct state funding is a small allocation for centers that specialize in Alzheimer's to help pay for extra aides trained in Alzheimer's. DSS makes grants to the Area Agencies for Aging, which actually disburse the funds to centers that apply for them. Some centers also receive limited amounts under the federal Older Americans Act Title III through the Area Agencies for Aging. They use this federal money to pay daily fees for patients who do not qualify for the CHCPE. In some cases, the Veterans' Administration pays patients' adult day care fees.

The state does not contribute any funds directly to starting up adult day care centers. These are usually started by nonprofit organizations or for-profit corporations. Sometimes a town will start one up in connection with its senior center.

Other sources include fees from private pay attendees, grants from private organizations, town funding, and charitable donations. Centers often have a sliding scale for fees for private pay patients depending on their income. Reimbursem*nt from long-term care insurance or other private health insurance is not a large factor now, but could become more important in the future.

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