Social life for the aging, respite for kin
CAPITAL REGION Diane Fleming can play tennis, bowl and do yoga, but she doesn’t know what day it is and has a tendency to wander.
When her husband died in November, her daughter, Laura Essa, took over her care but soon realized she couldn’t manage it on her own.
Essa’s search for respite led her to the Bright Horizons adult day center at The Beltrone Living Center in Colonie, which is run by Colonie Senior Service Centers.
“She wouldn’t interact at all when she first started, but now she’ll sit and help with a puzzle. She’s actually doing the activities,” the Clifton Park resident said of her 72-year-old mother, who has Alzheimer’s disease.
The program has helped keep Fleming active and has given her daughter a much needed break.
“It was really a lifesaver to find this program,” Essa said.
Local adult day care centers are seeing increased demand for their services as the elderly population increases and the number of potential caregivers declines.
An amendment to the Medicaid program, which began rolling out in the region in December, also could cause the number of adult day care participants to jump.
Adult day care centers operate on either a medical or social model. Participants must have functional impairments to participate in either program.
Social models, like Bright Horizons, are regulated by the New York State Office for the Aging. They have an emphasis on social interaction, but may also include assistance with activities like showering, eating, ambulating and using the toilet. Employees can’t administer medications but can prompt attendees to take them. Meals, exercise, entertainment and hands-on activities all are included.
At Bright Horizons, participants bake, play bingo, garden, exercise, sing and dance.
“Our big focus is to really help them maintain that sense of independence, so still doing what they can, still enjoying what they can, still creating friendships,” said Director Kristin Vivian.
Participants average around 84 years of age, but range from 60 to 92, she said.
Medical models, known as adult day health care programs, serve people with more acute needs.
“Adult day health care is basically providing all of the services you could get at a nursing home using the same levels of staff, but you get to go home at night,” explained Christine M. Fitzpatrick, executive director of the Adult Day Health Care Council.
Adult day health care programs are regulated by the Department of Health. Their services have been covered by Medicaid since the early 1970s, according to Fitzpatrick. Programs are located in nursing homes or other buildings that meet health facility standards.
Schuyler Ridge Adult Day Health Care Program in Clifton Park provides care for stroke survivors and people with conditions including Alzheimer’s disease and other forms of dementia. Participants’ average age is early 80s, but the program has served people ranging from their early 40s to 102, manager Tracy Hopsicker said.
Registered nurses and certified nursing assistants perform wound care, manage oxygen and administer insulin. Physical, speech and occupational therapy also can be provided.
“Anything they need medically, we’re able to provide,” said Hopsicker. “It’s a safe environment for them to be in. We have eyes on them all the time.”
The program, which costs $95 a day, includes snacks, lunch and activities like crafts and music programs.
The cost of adult day health care averages $85 a day in the Capital Region, according to Fitzpatrick.
“You may have to spend more to send someone to an adult day health care program, but if you can avoid a couple of hospitalizations a year, that’s going to be well worth the trouble and the cost,” she said.
Social adult day care costs, on average, $50 or $60 a day, said Barb Diesem-Zimmons, executive director of the New York State Adult Day Services Association.
Bright Horizons charges $40 a day, a price that includes breakfast, lunch and a snack.
“It’s a great way for people to remain in their home longer and be able to kind of bridge that gap, especially if they’re on a more narrow income,” said Vivian.
Attendees say they enjoy the socialization that adult day care programs provide.
“It’s good to have places like that, because what are you going to do at home all day? Nothing. Especially when you can’t do very much. You’re just sitting there and it’s depressing, and it’s really nice to come,” said 86-year-old Mary Clark of Albany, a Bright Horizons participant.
Securing adequate funding traditionally has been tricky for social adult day care centers, said Edward Neary, executive director of The Beltrone Living Center.
The Bright Horizons program housed at Beltrone relies on private payments; funding from the Albany County Office for the Aging, various visiting nurses associations and the town of Colonie; and occasional grants.
“If a person wants to come to the program, we’ll figure out a way to get them into the program through some kind of funding,” Neary said.
The funding crunch may ease slightly for social adult day care centers thanks to a Medicaid redesign instituted in 2011 by Gov. Andrew Cuomo. One provision is mandatory enrollment in managed long term care. Individuals who need 120 days or more of home care annually and meet certain other criteria automatically will be enrolled into either a social or medical adult day care program. Social programs were not covered by Medicaid in the past.
“It’s much cheaper to have even a full day of social adult [day care] than to have an aide travel to your home, do all of the things they do in your home, plus you’re still socially isolated once they leave,” explained Diesem-Zimmons.
The mandatory enrollment plan rolled out in Albany County in December. It is slated to take effect in Saratoga and Schenectady counties June 1 and in Montgomery, Fulton and Schoharie counties July 1.
AARP is advocating for $26 million to be included in the state budget to ensure everyone in need of an adult day care program can attend, said spokesman Eric Kriss.
Last year, the New York State Office for the Aging provided about $872,000 worth of funding for social adult day care.
“When you look at the need in the state and the value of what caregivers do, appropriating around $872,000 is simply not enough,” said Bill Ferris, lobbyist and legislative representative for AARP.
Adult day care is much more economical than nursing homes, which cost residents an average of $303 a day in the Northeast, he pointed out.
Inclusion of adult social day care in the Medicaid program could increase demand for services, but local providers say demand has been increasing without that measure.
Bright Horizons, which started in 1985 as a social day service for a single person, now has three centers and is considering expanding into Clifton Park. It also is moving one of its programs to a larger location in Karner Plaza in Guilderland.
Kingsway Senior Residential Community in Schenectady is looking at adding a social adult day care program to its offerings, noted Diesem-Zimmons.
At Wesley Evergreen Adult Day Services in Ballston Spa, demand for services is up. Last summer, for the first time in the three years site manager Diana Martin has been working there, the program had a waiting list.
“People are becoming a little more aware of adult day service, which allows them to still stay home,” she said.
Demand for social adult day services is increasing across the state, said Diesem-Zimmons.
In contrast, enrollment is fairly stagnant statewide in adult day health care, said Fitzpatrick.
Schuyler Ridge’s program is an exception.
“We have people calling us all the time because they’re trying to get to work, trying to figure out how they’re going to take care of mom and dad at home because they still have to work, they have kids, they have things they need to get done,” Hopsicker said.