If you don’t offer adult day programs, you might miss a golden opportunity
Services ranging from treatment to day care attract payers, patients
If your facility wants to expand the type of care it offers, consider setting up a day program to provide therapy, supervised social and leisure opportunities, or simply respite care for adults who don’t need full-time institutional care but aren’t well enough to function independently. CARF...The Rehabilitation Accreditation Commission, with headquarters in Tucson, AZ, will begin accrediting adult day programs in July.
"The issue of day services is timely today because the market is repricing what it costs for health care, and all parties are looking for less costly options to traditional care," says Nancy Beckley, MS, MBA, president of the Bloomingdale Consulting Group, a rehab consulting firm in Valrico, FL. "Everybody is interested in day programs. The patients are interested. The doctors are interested. The providers are interested."
The needs are greatest for people with long-term, chronic needs, such as those with head injuries, stroke, and Alzheimer’s disease, she says. Such patients don’t need intensive therapy, but they require supervision and help with their activities of daily living.
Donald E. Galvin, PhD, president and chief executive officer of CARF, says, "Adult day services are critically important to Americans, especially as the baby boomer generation enters its retirement year."
CARF accreditation standards for adult day programs were drafted by a national advisory committee from CARF and the National Adult Day Services Association, a unit of the National Council on Aging in Washington, DC.
According to the National Adult Day Services Association, the number of adult day centers has nearly doubled in the 1990s to keep pace with the demand for home and community-based care. About 4,000 adult day center in the nation provide health care, therapeutic services, and social activities for people with functional or cognitive impairments.
CARF expects to accredit between 300 and 500 adult day services programs within the next five years, says Christine MacDonell, national director of CARF’s adult day services accreditation division. (For a list of CARF conferences on adult day services, see box, below left.)
If your facility chooses to open a day program, you have three options:
1. Day treatment programs offer the same kind of intensive, interdisciplinary therapy a patient would receive in an inpatient facility, but on an outpatient basic. Patients in this type of program are expected to be able to make progress and have a limited length of stay. (See related stories, pp. 20-24.)
The target market consists of patients who are discharged from the hospital but are unable to function independently. Many of these patients otherwise would need to be in some kind of supervised living situation such as a subacute facility or nursing home.
2. Day health care programs offer some health and therapeutic activities and a range of social and leisure time activities. Some clients in this type of program may move on to a higher level of care, such as school or sheltered workshop.
3. Adult day care programs provide only day care or respite care for people who can’t be left unsupervised. Clients in this type of program eventually may be moved into a skilled nursing facility.
Which kind of program you decide to open should depend on your community’s needs, the staff and space you have, and what you offer in the rest of your continuum of care. There are advantages to each type of program, the experts say.
HealthSouth Rehabilitation Hospital of Charleston, SC, offers an intensive day treatment program for neurology patients that includes up to five hours of therapy per day, with an emphasis on cognitive activities. The program is fully covered by many insurers, who have approved payment for up to a year because it helps patients avoid going to long-term care, says Michele Skripps RN, case management coordinator.
When Casa Colina Centers for Rehabilitation opened its Adult Day Health Care Program, the hospital committee looked an adult day care program instead of an adult day health care program, says Kim Mory, MA-SP, CCM, director of the Pomona, CA, day program.
While private and federal payers cover adult day health programs, which have a medical component, insurers don’t cover adult day care, which severely limits the patient base, Mory says. The program has to be fully staffed from its onset, even though there may not be many patients initially. Although the cost of staff makes the program lose money at first, once the client base reaches 50 or 60, the program begins the make a profit, she explains.
"If we didn’t have to have a lot of highly paid staff, we could charge $35 a day instead of $66 a day, but few people have the resources to send their family member five days a week at $35 a day for very long," she adds.
The $66 daily rate covers meals, activities, and therapy.
MediCAL, California’s Medicaid program, pays for most of the clients to attend Casa Colina Centers for Rehabilitation’s Adult Day Health Care program. Many are patients whose private insurance benefits have ended due to their catastrophic illness or injury. Recently, a Medicare provider allowed two clients to come two days a week as a pilot project, and one private insurer has agreed to pay for the program, Mory adds.
Private-pay clients
At the other end of the scale, West Georgia Health System in LaGrange, GA, has an adult day program that provides structured activities. So far, clients or their families have paid for its services.
The health system administration chose to set up its adult day program as a social model rather than a health care model because it doesn’t require licensed staff, says Mary Lynn Faress, RN, vice president of the health system. In Georgia, adult day care services don’t have to be licensed, but they do have to meet state standards for square footage per client, health department inspections, and other criteria.
Because the adult day care center is in the hospital’s skilled nursing facility, the program breaks even as long as several patients participate, she says.
Rehab professionals who offer day programs suggest considering these factors before setting one up at your facility:
• Don’t expect to make the level of money you might make in other therapy programs, Beckley warns. "Day treatment is not a money-making proposition. You don’t have the same margins you have in a regular therapy program."
• Look at your costs and determine if you can make a profit or at least break even with prevailing rates in your area, Beckley suggests.
• Consider taking patients or clients on a trial basis to make sure they fit with your program’s activities, Mory advises.
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