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Do Not Throw the Good Out with the Bad

Thursday, May 09, 2013

This opinion piece, by UNH Executive Director Nancy Wackstein and Policy Analyst Carin Tinney, was originally printed in the May 9, 2013 issue of the New York Nonprofit Press. Read the original piece here. 

 Until very recently, most New Yorkers hadn't heard of something called social adult day care. If they did, perhaps it conjured up images of frail seniors on small plastic chairs, drinking from ½ pint milk cartons while having a story read to them by a teacher.  That is why the attention now being paid to this program - due to the recent scandal involving two Bronx Assembly Members and the resulting articles in the New York Times about alleged abuses by “pop up” social day care providers-  is bittersweet.

The unfortunate impression is that this program is at best unnecessary and at worst riddled with fraud, political kickbacks and unscrupulous operators.  But the attention, however negative, does give us a chance to highlight the benefits of this program, which when done the right way by credible and professional providers, has helped thousands of genuinely frail seniors remain independent in their communities and has given their family caregivers essential support and respite.

 The social adult day care model has been around for decades. In many cases, there is a dual focus on providing supervised care and support to seniors while allowing family caregivers a few hours of relief. Social adult day care specifically supports seniors who would have a difficult time adapting to a bustling environment of a traditional senior center  because of their frailty or dementia. These seniors are dependent on continuous care and need extra supervision, usually with eating, using the bathroom, or walking.  The benefit of the social adult day care model is that it allows otherwise homebound older adults to get out and socialize with their peers through art, shared meals, exercise and music.

The challenge to the model, as it was designed, began about a year ago. Many senior center operators located primarily in immigrant communities began noticing a decrease in daily attendance.  As a general rule, the number of seniors served varies on a daily basis, but this was not normal fluctuation.   Seniors were being lured out of senior centers and into “adult day care programs” with cash and other incentives.  This was alarming on many levels.  First, the seniors leaving for adult day programs were not physically or cognitively frail, which is the main eligibility criterion of social adult day care.  Second, this exodus jeopardized funding for traditional senior centers because reimbursement partially depends on the number of meals served daily.  Third, it was clear that these new “social adult day care” programs were unregulated and were not using precious Medicaid dollars in the way it had been intended:  to help frail seniors remain in their communities.  The new centers called into question the integrity of the entire model and cast a shadow on the longstanding history of many quality-driven programs

United Neighborhood Houses, the federation of the city’s settlement houses and community centers, has within our membership some of the finest and most experienced providers of social adult day care.  UNH members helped pioneer the concept and some of their adult day care programs have been operating for over a decade.  It would be a horrible shame for these legitimate and important programs to be swept up in an enforcement reaction meant to shut down the Medicaid cheats.

Legitimate social adult day care programs are one of the components of a comprehensive continuum of care for older adults in their neighborhoods. They greatly benefit a population in need of specialized and supervised care, and contribute to a better quality of life for both seniors and their caregivers through constant emotional support. This program deserves not only to continue but to expand in order to accommodate the dramatic increase in the number of older adults who are projected to need this kind of care.  Let’s not allow a vulnerable population to become the victims of a few dishonest program operators. Don’t throw the good out with the bad.

Nancy Wackstein in Executive Director of United Neighborhood Houses.  Carin Tinney is a Policy Analyst with UNH.

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