This is somewhat embarrassing, isn’t it?

The Perfect Vehicle for the Journey Through Life 50+
Current statistics say 69% of us will need some form of rehabilitation and help
before we leave this world. https://longtermcare.acl.gov/the-basics/how-muchcare-
will-you-need.html
When I ask people how they envision the last third of their lives, they often tell me
about how they have saved for their retirement and have purchased long term care
insurance to pay for their care, should they need it. I commend them for their good
planning and saving habits. Then I point out that they have told me how they are
going to pay for their lifestyle and help, but they have not told me what they are
spending their money on. In other words, where will they live, and who will
provide the rehabilitation and help? I liken it to having the gas, but no car!
In the beginning, families lived close to one another. Children, parents,
grandparents, great-grandparents and other extended family members took care of
one another. Those who did not have family were cared for by charitable
institutions, mainly churches. Government did not care for the financial needs of
older U.S. citizens until 1940 for social security
(http://www.ssa.gov/history/hfaq.html) and for their medical and custodial needs
until 1965, when President Lyndon B. Johnson signed amendments to the Social
Security Act, beginning the Medicare and Medicaid programs
(http://www.cnbc.com/id/43992654/Medicare_and_Medicaid_CNBC_Explains) In
1965 the average life expectancy was 66.80 years old for males. Now we are living
longer and longer. Seventy five point eighty one is the new average lifespan for
males today and predictions for this generation of young people reaching the age of
90 seems reasonable (http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195)
Medical technologies have improved greatly in recent years and are continually
and rapidly increasing.
These blessings come at a cost. In addition to the problem of finding the money
needed to live more years and to pay for the medical technology to make that
happen, other problems stem from the lack of unpaid care that used to come from
family members. Families are increasingly fragmented in the modern U.S., and
women, who were the caregivers of the past, have careers that preclude them from
the demanding role of care-giving. Who is going to take care of the elderly and
frail in America and who is going to pay for it?
State and Federal governments are already experiencing heavy deficits, and with
the approaching tsunami of aging baby boomers, the future looks grim. Skilled
nursing care homes, the current care giver of choice for the Medicaid program in
Kentucky, are the most costly form of care because the care is twenty four hours a
day, three hundred and sixty five days a year in an institutional setting. Medicaid
home and community based services exist but are not well known, are difficult to
implement, and funds are lacking. To be eligible for government programs,
poverty must be established. Impoverishment can happen quickly when one must
pay the costs associated with long term care unless adequate insurance has been
purchased ahead of time, which will pay for skilled nursing care in a nursing home
or in one’s own home, or for care in other settings.
Another form of insurance is for an individual to take care of one’s own health in
hopes of never needing custodial or skilled nursing care. That is why Medicare
supplemental insurance companies are happy to sponsor the Silver Sneakers
program. The more one exercises, the less one is likely to need medical care that
the insurance company will have to pay for with our premiums.
Adult day centers have long been utilized for the mentally and physically
challenged eighteen-year-olds and older who age out of the public school system.
Adult day centers have not been known as a preferred choice for the over fifty
population who want to stay as healthy as possible and have a higher quality of
life. However, adult day centers have the potential for becoming the perfect vehicle
for solving many of the problems we are facing as an aging population and the
accompanying escalating costs.
Words are important. Names are important. Instead of calling them adult day
centers, let’s call them “health clubs for seniors”. Each center can be a clubhouse,
with a name of it’s own. Our clubhouse is called the Fountain of Youth Clubhouse.
The people who decide that they want to join the health club in hopes of living
better, longer, are called “members”. As with any organization, each clubhouse has
it’s own culture. Our clubhouse has a culture of uplifting and upscale mentally
stimulating activities and food fare offerings, alternating with carefully designed
physical activities. We are very intentional about not allowing topics related to sex,
religion or politics in our programming. At the heart of what we do is a tool called
the Wellness Map. The Wellness Map is individually designed for each member
and contains the medical history of the member, emergency information, and
recommendations for helping each member to their best health and quality of life.
Of course, the old adage, “You can lead a horse to water but you can’t make it
drink”, holds true here. No one can be forced to improve their health and quality of
life. Possibly one of the most important sections of the Wellness Map is the
HIPAA Healthcare Authorization Section which leads into the plan for what the
member would like to happen if they were no longer capable of making decisions
for themselves. Ideally, members will join when they are in their fifties and come
to the clubhouse when they would like to ask the nurse a question or when they
would like to participate in a club meeting or special event. Imagine this scenario:
Tom has been coming to the clubhouse for 10 years. He is a successful engineer
with a large corporation in town, he is single and has no local family. He first used
our services when he had a colonoscopy scheduled, which required he had
someone drive him there and back and stay with him while he recovered. He
discovered our Friday afternoon cornhole games and came religiously as a
volunteer for years. One day, however, the staff noticed he was wearing the same
shirt with a blueberry stain for the second week, which wasn’t like Tom. He was a
meticulous dresser. Concerned, the staff asked if Tom was still driving his
Corvette, and could she see it? The staff person was surprised to see that the
Corvette was dirty and had a few scratches on it, also unlike Tom’s habits. Tom
was upset when the staff person questioned him about the scratches, claiming that
they must have just happened! The staff person calmed him down by suggesting
they go inside and make some phone calls, but once inside, Tom forgot about the
Corvette, especially when the staff person asked him to play a game with her. The
game was a mini mental exam disguised as a game. The mini mental exam is
designed to determine if further investigation is warranted in case one has
dementia. Tom did not do well on the exam. The staff person consulted with the
nurse on duty, who contacted Tom’s doctor, and an appointment was made and
transportation arranged. After the appointment with Tom’s doctor, and a
subsequent appointment with a dementia specialist, Tom was diagnosed with mid
stage Alzheimer’s disease. Fortunately for Tom, he had created a plan in his
Wellness Map and with his lawyer’s help, the club worked to implement the plan.
Tom’s plan was to stay in is current home and have help at home until the very
end. His plan also included coming to the clubhouse full time for supervision and
safety as long as possible to improve his quality of life, improve outcomes, and to
save money. Statistics show that adult day attendance can slow the progression of
dementia. We work with our member’s personal physicians and lawyers to ensure
the best outcome for our members.
Adult day centers are licensed by the state of Kentucky as Healthcare Centers with
Nursing Services. Nurses are required to be on the premises during hours of
operation. The cost for adult day center attendance varies but is usually based on
the Medicaid reimbursement rate of $11. per hour. People who are in need of
medical care, and who would otherwise be in a nursing home if not for the services
of the adult day center and a caregiver in the home, are eligible for a home and
community based waiver from Medicaid to pay for attendance at the adult day
center and for help at home. Most long-term care insurance will also pay for
attendance at an adult day center and help at home. Even if one must pay out-ofpocket,
adult day center attendance combined with help at home costs about the
same or less than skilled nursing care.
As with any choice we make concerning expenditures, it pays to do our homework
and shop around. Below is a website to help with the process:
http://nadsa.org/consumers/choosing-a-center/
Below are some questions that one should ask when shopping for an adult day
center and how we answer for our Fountain of Youth Clubhouse, in blue:
1. What is the staffing structure of the facility?
Ask about the ratio of patients to staff members and the availability of clinical
supervision if the center is providing medically related services. Is there a
manager or supervisor on staff at all times, even during extended hours? What
special training does the staff receive to work with special needs such as dementia?
The Fountain of Youth Clubhouse has a maximum of 10 members in attendance
daily, and a minimum of two staff at all times, one of whom is a nurse. There is a
supervising nurse on staff also. Staff receives training in the best practices for
dementia patients and emergency procedures.
2. Is the adult day care center licensed or otherwise accredited?
If your state offers an adult day care license it’s important that the center has an
active license. Some states do not offer these licenses. If this is the case, there
may be a great deal of difference between individual centers, therefore it is
important to learn more about each of the centers near you. You will probably want
to visit the centers closest to you and talk with the staff and other families that use
the centers to determine if the facilities and programs available meet your
individual needs. The Fountain of Youth Clubhouse is licensed as a Healthcare
Center with Nursing Services from the Kentucky Cabinet of Health and Human
Services. The Clubhouse is also subject to audits and recoupments from the
Department for Medicaid Services.
3. Are there a minimum number of days per week, or hours per day?
Most centers require a half-day’s participation. Ask how far in advance
participation needs to be scheduled and if there is any penalty for unplanned
absences. There is no minimum hours or days of attendance. We do offer a
discount for prepaid full time monthly attendance.
4. What does the center require for admission to the care program?
Some centers require documentation from a recent physical exam or special tests
such as tuberculosis. If the center is providing medically based assistance they may
require a physician’s order for some treatments. If medications are to be
administered they may require the prescriptions be filled directly by the center.
A Wellness Consultation with our nurse is required before one is accepted as a
member, complete with pertinent medical records, and a list of prescriptions. If
medications must be taken at the Clubhouse, the medication must be brought in an
up to date prescription bottle, and only the current day’s dosage must be checked in
daily.
5. Can the care center accommodate participants with special needs?
Not all adult day care centers are staffed to serve clients with special physical
needs such as blindness or extreme hearing loss. Most centers, but not all, can
provide for clients who are incontinent and need hygiene management throughout
the day. Wheelchair access is generally considered in the layout of adult day care
facilities; however, check to make sure that lack of mobility will not prevent full
participation. The Fountain of Youth Clubhouse is completely compliant with all
ADA recommendations. We help our members with all personal care needs in the
form of spa treatments, and each member’s Wellness Map outlines their needs for
personal and medical care.
6. Is there written documentation to instruct staff how to handle
emergencies?
Evacuation plans should be well documented as well as procedures to handle
medical emergencies of an individual participant. The Fountain of Youth
Clubhouse has extensive emergency planning for all conceivable forms of
emergencies and practices drills monthly. Diagrams for exits are in each room.
7. How much does adult day care cost?
Costs vary among adult day care centers but are usually much lower than the cost
of an in-home caregiver for the same length of time. Costs range from $25 a day
to over $100 per day depending on the services offered, type of reimbursement,
and geographic region. The median annual rate for adult day health care in the
U.S. is $15,600, according to the Genworth 2011 Cost of Care Survey. The
Fountain of Youth Clubhouse is $73 per day and we offer a deep discount for
monthly pre-payment. We also offer an hourly rate of $16 an hour.
8. Do I have to pay for this or is some of it covered elsewhere?
Adult day care programs are generally paid for by the client, but sometimes the
cost can be offset through Medicare, Medicaid or other community-based subsidies
or federal and state programs, such as the Older Americans Act, the Veterans
Administration, and others. Some long term care insurance policies have a benefit
that will reimburse the policyholder for adult day care expenses. Some of our
members pay for our services out of pocket (we take check, credit cards, ach
automatic withdrawals) or with long term care insurance if they have home and
community based coverage. Some Medicare Supplement Insurance Policies (also
known as Part B) offer an adult day center benefit. Medicaid Home and
Community Based Waiver is income and asset based and if a member qualifies,
Medicaid will pay for our services. Also, the Veteran’s Aid and Attendance
Program will pay for our services.
9. My dad has Alzheimer’s disease. Can he participate in an adult day care
center?
Some centers have special programs for those with Alzheimer’s disease or similar
types of dementia. These programs focus on activities that encourage participation
and nurture the special needs of these individuals. Adult day care centers should
also be able to provide a stimulating environment to adults with adequate cognitive
skills but who suffer from physical limitations. Most adult and senior day care
centers have staff members who are trained to focus on the client’s ability to
socialize and participate in activities. We have special programs for those with
Alzheimer’s disease or similar types of dementia. Our programs focus on activities
that encourage participation and nurture the special needs of the individual. We
also provide a stimulating environment for adults with adequate cognitive skills but
who suffer from physical limitations. We have staff members who are trained to
focus on the client’s ability to socialize and participate in activities.
10. What are the social programs like?
Many centers have well-trained activity specialists who lead dynamic activities
programs. These programs might include arts and crafts, intergenerational
programs, music, cooking classes, exercise sessions, movies, discussion groups,
live entertainment and trips into the community. Some care centers offer programs
that are especially designed for physically frail individuals with special medical
needs such as diabetes, hypertension and post-stroke disabilities, and those with
mental health challenges such as dementia, confusion and Alzheimer’s disease. We
have well trained activity specialists who lead dynamic activities programs. Our
programs include arts and crafts, intergenerational programs, music, cooking
classes, exercise sessions, books (no movies), discussion groups, and live
entertainment. We offer programs that are especially designed for physically frail
individuals with special needs such as diabetes, hypertension and post stroke
disabilities as well as those with mental health issues such as dementia.
A good tip to remember: take a tour of a center before you send your loved one
there so you can see for yourself what the staff and surroundings are like. Please do
come to visit the Fountain of Youth Clubhouse! Make an appointment or drop in
M-F 10 to 4.
We are unlike any other adult day center or home care agency because we work
with our members to help them to their best health and quality of life using The
Wellness Map and The Guidebook (n.a. for Medicaid Members). The Wellness
Map and The Guidebook are designed to be legally binding documents containing
the wishes and instructions of our members concerning their care. We can keep our
members in their homes until the end, if that is their desire, in most circumstances.