In late November, the aging-focused advocacy organization LeadingAge wrote a note to Congress, calling for relief on behalf of the 5,500 adult day service providers across the country and the vulnerable patients they serve.
“Adult day services providers across the country urgently need dedicated federal funding to ensure they are able to continue providing services during and after the COVID-19 pandemic ends,” the letter read.
It was signed by LeadingAge President and CEO Katie Smith Sloan and Donna Sizemore Hale, the executive director of the National Adult Day Services Association.
Unlike other health care providers across the care continuum, adult day providers haven’t been the benefactors of any major funding from the federal government. Meanwhile, state mandates have kept adult day operators completely closed, or opened at just 30% or 50% capacity.
A lack of government relief and a major loss in revenue due to limited capacity or complete closures has left the adult day world in deep trouble.
“I think we definitely do need to appreciate that operating at 30% to 50% capacity — or whatever the capacity limit is — is going to have a huge financial impact on any organization over a long period of time, whether they are adult day operators or a business in any other industry,” Brendan Flinn, the director of home- and community-based services at LeadingAge, told Home Health Care News.
Operators are prioritizing safety as they open. That frequently means reopening at reduced capacity, which means a reduced bottom line as well — and sometimes an unsustainable one.
It also means additional expenses, even with a greatly reduced number of members. For smaller adult day operators, those expenses consist of purchasing safety equipment such as PPE and plexiglass in lower quantities — and, thus, at higher prices.
LeadingAge’s letter to Congress included an asking price of $422.5 million to support providers and the over 260,000 individuals they serve.
Worst of all, a lack of support means that the vulnerable individuals that frequent adult day centers are left behind. Reduced capacity squeezes out members in need of care and socialization.
“I was on a call with some of my providers last week that had recently reopened, … and they were talking about their members, and how they had lost a ton of weight, how they’ve declined cognitively,” Flinn said. “Whatever health conditions they had, they had been exacerbated.”
Those providers had also reported that once they had reopened and welcomed members back, all of those aspects had begun improving.
But that’s for the ones lucky enough to return to adult day centers amid the ongoing public health crisis. For the ones that haven’t, those conditions are likely to continue worsening, bringing stress to them and their families.
Adult day centers are a great resource for lower- and middle-income families. They offer care and socialization to seniors at an often lower, more feasible price.
According to Genworth Financial, the 2020 national median cost of adult day services was $1,603 per month. Comparatively, the assisted living cost was over $4,300 per month, while nursing home care was about $7,750.
“It’s similar to anything else we’ve learned from data, research or anecdotal reporting … we’re seeing the effects to a greater degree for lower-income families and communities,” Flinn said. “We know that adult day services are a great way for [these] families and individuals to receive some type of services if they are not eligible for Medicaid and can’t afford something like a nursing home, but need some sort of care.”
The distribution of funds
It’s not that the Provider Relief Fund, for instance, cut out adult day providers. Instead, it’s that once those funds were released to the U.S. Department of Health and Human Services (HHS), the agency did not include them among the providers who would receive relief.
Phase Two of the Provider Relief Fund — for the most part — was the only phase that adult day providers were able to access. Even then, it was designated for providers that had billed Medicaid, and resources were extremely limited.
“These funds were turned over to HHS, and it made the decision about where those funds went,” Flinn said. “So [HHS] were the ones who decided that Phase One would include Medicare Part A, they were the one that decided what providers would get what type of relief.”
So, if there is another relief package coming down the pike, it’s likely to be distributed the same way. And that would still likely leave adult day providers behind. Some states have been better than others when it comes to adult day relief funding, but it has not been enough to make up for the lost ground from a federal standpoint.
To make matters worse, in the recent and initial federal recommendations for vaccines, adult day providers and their members were not included in the highest priority group.
Elder-Well, a non-medical social model for adult day care, had high hopes in January of this year.
The Framingham, Massachusetts-based company was founded in 2014 by home health veterans Kara and Ken Harvey.
The Harveys were set to begin growing their business by franchising locations in Massachusetts and Florida, offering discounts for potential franchisees. The couple hoped to add 10 in 2020.
“Adult Day is — and is going to be — a very preferred long-term care option,” Kara Harvey told HHCN. “And so before the pandemic hit, we had many people throughout the country interested in joining the franchise system, and then that halted.”
The Harveys have noticed the recession sparking more interest from entrepreneurs of late, but have held back on opening up a slew of new locations given the uncertain regulatory climates in the two states. While they recently opened a new Elder-Well location, they’ve fallen short of their aspirations for obvious reasons.
Adult day centers were also labeled non-essential in both Florida and Massachusetts.
“That was painful,” Harvey said.
In Florida, however, they were allowed to open back up in May. In Massachusetts, adult days weren’t allowed to reopen through the summer.
Elder-Well wasn’t eligible for larger Paycheck Protection Program (PPP) loans. And because it is a social model that does not receive money from Medicare and Medicaid, the only way they were able to recoup some revenue during the public health emergency was to offer virtual solutions.
“It was difficult, I think, for all service providers in the senior care industry, but particularly for adult day,” Harvey said. “Those that weren’t able to pivot instantly and set up a virtual option really took a hit.”
Elder-Well has leveraged a partnership with the cognitive assistance company MapHabit, as well as Zoom and Facebook Portal, to stay in touch with its members.
After keeping its head above water virtually in 2020, the company has tempered its expectations. Now, it hopes to open six locations in 2021.
“Whether it be a social or a medical model, adult day centers are key in order for seniors to continue living at home in each community,” Harvey said. “There needs to be more insight provided for the lawmakers to understand that, and to appropriate funding and support for programs.”