January 10, 2008

Choices Grow for Increasing Numbers Of Baby Boomers Who Have Frail Relatives. They Are Reluctant to Leave Alone

On any given day, Luther Manor, in the suburbs of Milwaukee, provides day-care services for 58 people. Demand has grown in recent years, and the center has no more slots. Now it's looking to build a satellite campus.

But the people left in Luther Manor's care every morning by commuters aren't children, they're adults -- the parents of the folks rushing off to work.

It's a scene played out every day at more than 3,500 day-care centers across the U.S., as baby boomers and others seek quality care for frail parents unable to stay at home alone. Some are looking for relief from the care they're providing around the clock. Others want an option that lets them go to work but is more affordable, reliable and stimulating than hiring a home health-care aide.

The result is that adult day care, an industry that began in church basements with bingo and bag lunches, is becoming an increasingly important player in the burgeoning business of elder care.

National data are sketchy, but individual facilities around the country report demand is growing at between 5% and 15% a year, depending on location. The National Adult Day Services Association, a trade group, reports that these centers care for about 150,000 residents daily. But the actual number enrolled is much higher, since not every person enrolled in a program attends each day. By some industry estimates, adult day care serves at least 400,000 people nationally.

Granted, the numbers remain relatively small. That's largely because "there's still a stigma attached to 'day care,' " says Sue Meier, administrator at Landmark Home Healthcare, which serves Pennsylvania 's Allegheny County , home to one of the oldest populations in the country. "People think, 'day care,' and think this is childlike care -- and it's not."

The federal Centers for Medicare & Medicaid Services last year began a three-year pilot program that allows a portion of Medicare home health-care benefits to go toward adult day care. Under the program, Medicare gets a 5% discount on what it otherwise would pay for a patient's home-health costs. Medicare, the federal insurance program for the elderly and disabled, otherwise doesn't cover adult day care.

Metropolitan Life Insurance Co. found that the national average cost for adult day care is about $61 a day. The hourly rate for a home health aide -- who generally provides custodial care -- is $19, or $114 to $152 for a six- to eight-hour day.

Of course, day care can turn into a nightmare. The Texas Department of Aging and Disability Services in 2006 found that among the 10 most frequent complaints are neglect, mental and physical abuse and theft.

Medicare officials say the results of its pilot program have been encouraging, though.

At Landmark Home Healthcare, in Allison Park, Pa., one of five Medicare pilot sites, hospital readmission rates for participants in the pilot project are less than half that for the population not participating. And at Neighborly Care Network, a not-for-profit operator of four adult day-care facilities in the St. Petersburg, Fla., area, 47% of the Medicare participants re-enroll after their Medicare dollars run out -- an indication that attendees and their family members increasingly see the benefit of adult day care.

In a nod to the aging of the population, MetLife last fall for the first time included adult day care as a distinct category in its annual report on costs in the long-term care industry. Adult day care "is becoming increasingly recognized within the long-term care community for the array of services available," says Kathy O'Brien, senior gerontologist with MetLife's Mature Market Institute.

The industry also has spawned franchising. Sarah Adult Day Services Inc., based in Canton, Ohio, had six centers before it began franchising its 22-year-old operation in 2004. Now it has 54 SarahCare Adult Daycare Centers either open or in some level of development in about a dozen states. Each center serves between 40 and 50 people a day, and offers day-spa services such as salons.

"We were getting a lot of requests from agencies that fund us and from our own families saying they wished we had a SarahCare" in more communities, says Chief Executive Merle Griff.

Next Up for Guitar Hero?

At its core, adult day care is custodial care for seniors who cannot care for themselves at home. It usually goes beyond a glorified sitter service, though, offering everything from medication management and physical therapy, to nursing care, exercise and grooming. States generally require that adult day-care centers be registered or licensed in some fashion, though laws vary. Most centers will have a registered nurse available during the day, particularly at centers providing medical treatments.

Activities range from cognitive games for dementia patients to baking and art classes. The Milwaukee area's Luther Manor has a German Club run by a local college student. The Foundation for Senior Living, a Catholic charity in Phoenix, is installing Nintendo Wii videogame consoles to entertain attendees and keep their minds and bodies active.

The foundation, which cares for about 600 participants in six centers around Phoenix each day, is set to open three or four more facilities over the next 18 months because of growing demand across the region. "Many seniors are living with family members, so we're offering in an adult day-care setting the kinds of services they'd find" at a nursing home or assisted-living center, says Guy Mikkelsen, the foundation's CEO.

Three years ago, Grace Tatum, in Milwaukee, left her job at FedEx Corp. to care for her mother, who has Alzheimer's disease. Ms. Tatum enrolled her mother at Luther Manor for four hours a day, five days a week, partly for the activities her mom needs and partly because of cost.

Security Questions

"I can't afford to have someone come in and sit with my mother for all those hours," Ms. Tatum says. Having her mother in a day-care facility also avoids security issues that might arise at home.

Medicaid, the state and federal program for the needy, generally will pay for custodial needs such as adult day care. But many elderly people have too high an income to qualify for Medicaid. "There's a growing demand among people who pay privately, and whose parents live with them, and who see this as a way to afford the care their parents need," says Sara Myers, executive director at the Washington Adult Day Services Association, a local industry coalition in Seattle.

Jan Nestler, executive director at Elder and Adult Day Services, a Bellevue, Wash., not-for-profit that operates four day-care centers around Seattle, says that in the past five years, private payment has grown to about 30% of the business from 20%. Enrollment growth has been so robust -- 10% to 12% a year -- that the group is closing a center that routinely hits its 40-person daily capacity and is opening a center that can accommodate 70 people a day. "We expect the new place will be filled in about three years," so the agency already is planning for another facility, Ms. Nestler says.

Sharpening the Mind

On a recent Friday morning at Francis House, in Baton Rouge, La., the day begins for its 30 or so participants as early as 7 a.m. Caregivers lead the group in the Pledge of Allegiance and in singing "God Bless America," trying to assess each person's mental acuity, which can change day to day.

A light breakfast of grits, fruit or cereal is served at 9 a.m., and a hot lunch arrives early afternoon. The rest of the day is filled with activities. In one part of the 8,000-square-foot facility, a worker stands in front of a white board quizzing 15 dementia patients about words that start with the letter "P" -- a way to stimulate recall abilities. Elsewhere, a Bible-study class is under way, while those in the "walking club" use the corridors as a track. A nurse makes rounds to check on health issues.

By 6 p.m., the last of the day's attendees heads home. The cost: around $60 for a day that can stretch to 11 hours, compared with local rates of $12 to $17 an hour for an in-home health aide trained to handle personal care and meal preparation.

Anna Lea, a computer analyst at a Baton Rouge hospital, brings her 84-year-old mother to Francis House each morning and picks her up by 5 p.m. Ms. Lea and her mother, who is in the late stages of Alzheimer's, live together, and Ms. Lea has no interest in putting her parent in a nursing home -- or at least wants to delay that for as long as possible.

Yet Ms. Lea must work, and her mom "needs more activity than she'd get with someone just watching her at home all day," Ms. Lea says. With adult day care, "I feel secure that she's in good care, and it gives me the opportunity to work and to do my errands before I pick her up."

Respect Your Elders

Adult day care is gaining popularity as baby boomers seek affordable, stimulating care for frail parents. Tips on choosing a provider:

Finding a center: Start with local Alzheimer support groups, or state or local agencies on aging, for a list of facilities. Also, ask for recommendations from friends, neighbors and co-workers.

Visit: Just as you would visit day-care centers before enrolling your child, visit providers before enrolling your mother or father. "Is this a place your parent would be comfortable," says Beth Meyer-Arnold, chairwoman of the National Adult Day Services Association. Ask about the staffing ratio and how it compares with state requirements. Determine what services are available, such as rehabilitation, and if they are referred out or handled in house. Use your senses: How does the staff talk to participants. How does the place look and smell? Show up at different times of day. Taste the breakfast and lunch.

Go to more than one: "All centers are different, and different ones have different programs," says Kathy O'Brien, senior gerontologist at MetLife. Some will have programs aimed at dementia and Alzheimer's patients, while others might only provide custodial care -- effectively a sitter service. Still others will provide a wide range of health services, such as medication management and various therapies.

Check licensing and registration: State laws and standards vary, but centers generally need to be licensed or registered with a state agency, typically one that manages elder affairs. Ensure that the center you choose meets standards and has no major violations.

Ask about transportation: Does the center provide transportation -- many have dedicated buses -- or is transportation available through other sources, such as a local agency on aging.

Inquire about a discount: Some centers will cut the price if you prepay and register for multiple days per week. At Francis House, in Baton Rouge, La., for instance, the daily cost of $65.45 is trimmed to $58.90 for families who prepay.