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ADULT DAY CARE;
January 23, 2009 | 2009-R-0035 | |
CONNECTICUT ADULT DAY CENTERS | ||
By: Nicole Dube, Associate Legislative Analyst | ||
You asked for an update of OLR Report 2004-R-0774 on adult day care centers in Connecticut. Specifically, you wanted to know their number, funding sources, and recent closures.
SUMMARY
Connecticut's adult day centers are community-based, nonresidential facilities where frail seniors and disabled adults can go during the day if they cannot be home alone. The state does not license adult day centers, but they must be certified by the Connecticut Association of Adult Day Centers (CAADC) in order to receive state funding. Currently, 50 centers are operating, 48 of which are certified. (Centers can operate without certification but do not receive state funding.) There are also two centers in Massachusetts and Rhode Island serving Connecticut clients; the Department of Social Services (DSS) certifies these centers based on their being licensed by their own states.
Adult day centers provide a range of social and medical services including supervision, social and recreational activities, medical and personal care, nursing and social work services, meals, and respite.
Adult day services are funded through both public and private funds. The main funding source is daily client fees, which can be paid by the state or the individual. The primary sources of state funding is the Connecticut Home Care Program for Elders (CHCPE), administered by DSS, but a few smaller state programs also pay these fees for eligible elderly or disabled individuals. Centers may also receive federal funds under the Older Americans Act distributed through the state's Area Agencies on Aging. Centers also rely on grants from private organizations and charitable donations.
According to CAADC, 13 centers have closed since 2005 (Eight centers closed in 2005, one in 2006, four in 2007, and none in 2008.) The association attributes these closings to inadequate funding and the shortfall between the CHCPE reimbursem*nt rate (currently $63.55 per person per day for a medical model center and $57.93 for a social model center) and the centers daily costs per person, which now averages approximately $80.00. And, centers have consistently objected to the state's requirement that this daily rate include their transportation costs.
CONNECTICUT ADULT DAY CENTERS
“Adult day centers” (also known as “adult day care centers”) are community-based, nonresidential centers where frail seniors and disabled adults can go during the day if they cannot be home alone. They provide services to help these individuals remain independent in their own homes as long as possible. Their services include supervision, social and recreational activities, therapeutic activities, medical and personal care, nursing services, meals, and respite.
Most attendees need some supervision or medical services during the day; family members care for them at night and on weekends. The centers are one way for elderly or disabled people to avoid or delay entering a long-term care facility and to enable family members caring for them to continue working or have some respite during the day.
Adult day centers generally operate on either a “social mode” or a “medical model.” The social model serves people who need supervision and activities to reduce social isolation, but it does not provide extensive personal care and medical monitoring. The medical model provides nursing, personal care, and other medical services. According to CAADC President Maureen Dolin, 41 of the state's certified centers are medical models and seven are social models.
Connecticut does not license adult day centers. But in order to receive state funding, centers must meet CAADC certification standards, which were developed in cooperation with DSS. A center could operate without certification if all its clients paid privately, but to qualify for state funding, it must meet the CAADC standards. CAADC is aware of two certified centers currently operating without state money. According to DSS's Debra Willis, there are also two out-of-state licensed centers along the border also serving Connecticut clients. These centers are certified by DSS based on their being licensed by their own states and are eligible to receive state funds. (A list of Connecticut's adult day centers is enclosed.)
PRIMARY FUNDING SOURCES
The main source of funding for centers is daily client fees, which can be paid by the state or the individual. Most funding is from the state, the majority of which comes from CHCPE.
Home Care Program for Elders (CHCPE)
CHCPE is a Medicaid and state-funded program that pays for home- and community-based services for infirm seniors age 65 and older who might otherwise require nursing home care. Services include care management, adult day care and foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services. An “access” agency determines the most appropriate service package for each participant. Higher income recipients must contribute to the cost of their care.
After the central DSS Alternate Care Unit determines financial eligibility and conducts a brief health screen, it refers the applicant to a regional access agency. These agencies perform three primary functions: coordination, assessment, and monitoring. Their care managers conduct a comprehensive in-home patient assessment, provide program information, assist the patient with the required paperwork, and develop the patient's care plan. If the patient agrees to the plan, the agencies coordinate and monitor service delivery, making adjustments when needed. OLR Report 2005-R-0931 explores this program in greater detail.
According to Dolin, CHCPE currently pays a daily rate of $63.55 per person for the medical model centers and $57.93 per person for social model centers. This rate includes coverage for transportation to and from the center.
State-Funded Alzheimer's Respite Program
The state-funded Connecticut Statewide Respite Care Program gives families who care for relatives with Alzheimer's or related disorders an occasional break by paying for up to $3,500 of respite services per year for patients with incomes up to $30,000 a year and assets up to $80,000. Participants can receive the respite care in their home, at an adult day care center, or nursing home. There is no age requirement for eligibility, but participants cannot be enrolled in CHCPE. 2007 legislation changed the program requirements to allow Medicaid recipients under age 65 to participate (PA 07-86). DSS administers the program in cooperation with the Area Agencies on Aging.
Other State Programs
Several other state programs pay for adult day care. DSS's Protective Services for the Elderly program provides services to elders who have been abused or neglected, including, if needed, paying for adult day care on a short-term basis. DSS also operates a state-funded, 50-person pilot program that provides the same homecare services as CHCPE to certain disabled adults under age 65. And the Department of Developmental Services Medicaid waiver uses funding to pay for services to people with mental retardation, including adult day care if needed.
Other Funding Sources
Some adult day centers receive funding under the federal Older Americans Act Title IIIb, IIIc, and IIIe (National Family Caregiver Support Act) for individuals who do not qualify for adult day services under Medicaid or other programs. DSS's Aging Services Division distributes these funds through the state's five AAA's. OLR Report 2008-R-0450 provides greater detail on this topic.
Centers also rely on fees from private pay clients, grants from private organizations and charitable donations. Centers often have a sliding fee scale for private pay clients depending on their income.
CLOSURES
Since 2005, 13 centers have closed. Eight facilities closed in 2005, one in 2006, four in 2007, and none in 2008. Dolin attributes these closings to inadequate funding and the shortfall between the CHCPE daily reimbursem*nt rate (currently $63.55 for a medical model and $57.93 for a social model) and the centers daily costs per person, which now averages $80.00. Moreover, centers have consistently objected to the state's requirement that transportation costs be absorbed within this daily rate. CAADC's testimony to the legislature's Appropriations Committee on February 16, 2007 notes transportation costs some agencies $16.00 per client per day. CAADC also noted that centers lose money when clients are absent due to inclement weather, the unscheduled cancellation of planned services, or other reasons.
HYPERLINKS
OLR Report 2004-R-0774, “Connecticut Adult Day Care Centers,” http://www.cga.ct.gov/2004/rpt/2004-R-0774.htm.
OLR Report 2005-R-0931, “Connecticut Home Care Program for Elders and Procedures at DSS Alternate Care Unit and Regional Access Agencies,” http://www.cga.ct.gov/2005/rpt/2005-R-0931.htm.
OLR Report 2008-R-0450, “Area Agencies on Aging Homecare Functions,” http://www.cga.ct.gov/2008/rpt/2008-R-0450.htm.
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