HomeMy WebLinkAboutAgenda - 05-20-2003-6aORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: May 20, 2003
Action Agen a
Item No. -Q
SUBJECT• Program Report on the Central Orange Adult Day Health Center Initiative
DEPARTMENT: Aging PUBLIC HEARING: (YIN) No
Advisory Board on Aging
ATTACHMENT(S):
MAP Goal/Objective on Adult Day
Health
Program Progress Report
INFORMATION CONTACT:
Jerry Passmore, Director, ext. 2009
Steve Reda, Adult Day Health Center
Manager, ext. 2017
Florence Soltys, Chair, Advisory Board
on Aging„ 962-4541
Jack Chestnut, Vice-Chair, Advisory
Board on Aging, 918-3210
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To receive as information a Special Progress Report on the Central Orange Adult
Day Health Center Initiative: Development and Operation.
BACKGROUND: Establishing an adult day health program was one of the top priorities (Goal
III-A, c1-3) identified in the Master Aging Plan for Orange County (see attachment). In FY
2002-03, the Board of County Commissioners approved the adult day health initiative and set
aside $40,000 to plan and implement the adult day health center initiative. Apart-time planner
was hired to direct the necessary planning and oversee the renovation of the Meadowlands
Drive site location. Specific tasks that had to be addressed before the doors could open were:
marketing, networking, facility design requirements, policy development and funding support.
It was agreed that the Adult Day Health Center Initiative would be a community partnership, not
a County program, and that anon-profit agency should be established to take over the adult
day health program as well as operate other programs designed for frail and disabled older
adults. The main goal of the program would be to prevent or delay the onset of
institutionalization of the participants and provide respite for family caregivers from all income
levels. Thus, a sliding fee scale was established (Program Report: Attachment #1 ).
Several community organizations committed their support to this initiative. They included:
1) Carol Woods contributed $18,400 for space rental and administrative costs;
2) Friends for the Senior Center in Central Orange supported the utility costs;
3) UNC School of Nursing provided contract nursing services required for Adult Day Health
Centers;
4) UNC Health Care designated $20,000 to supplement low income participant payments
5) Kerr Drug and Medical Supply Superstore provided medical and incontinence supplies
($1000+); and
6) Local banks gave donations-CCB ($250) and Hillsborough National ($300).
In order to establish the Adult Day Health Center as a teaching model, several UNC Health and
professional schools (Social Work, Occupational Therapy, etc.) have also agreed to place
students on an ongoing basis.
The Adult Day Health Center renovation and special facility requirements were completed in
Fall, 2002. Staffing agreements (UNC School of Nursing, Health Solutions) were signed, and
all staff were hired and trained in December, 2002. After extensive local and State program
review, the North Carolina Division on Aging issued a state adult day care operators license in
March, 2003. The Adult Day Health Center began operation on March 28, 2003 once a food
service arrangement was reached with Classic Foods and delivery by Orange Community in
Missions (OCIM) volunteers. The Advisory Board on Aging with Department on Aging staff are
now proceeding with the incorporation of a new non-profit organization to assume Center
operation from the County by January, 2004. It is important for the BOCC to review the draft
bylaws for the new nonprofit at its June 3~d meeting in order to complete the incorporation and
tax papers by December 2003. The Department on Aging plans to prepare a continuation Adult
Day Care budget for FY 2003-04. After a month of operation, the Center currently has enrolled
7 participants who come on full and half-day schedules. The program can handle up to 10
participants per day.
FINANCIAL IMPACT: In order to serve low-income older adults, rather than just private full pay
participants, both public-private agencies will need to continue to support the Adult Day Health
Center for at least the next few years. Otherwise, Adult Day Health will either discontinue or
only serve full-pay participants. The Advisory Board on Aging has recommended maintaining a
$40,000 County level of funding for FY 2003-04 with a gradual reduction over time as
federal/state reimbursement rates increase to support low-income participants. Ultimately,
Adult Day Health is more cost-effective in helping older adults aging in-place in their home.
(Program Report: Attachment #2)
RECOMMENDATION(S): The Manager recommends that the Board receive this update as
information only.
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Orange County
Master Aging Plan
Adopted by
The Board of County Commissioners
March 6, 2001
Adult Day Health Program Initiative
GOAL'lll-A: To'recognize and support the efforts of
informal caregivers in providing care_to older
persons-ir~~range County,
c) Adult Day Health/Social Service
FY 2001 Objectives -Goal III-A
cl) Research the need for an adult day program (social and health model) and design
a program based on the results of the research.
Lead agency: OC Dept. on Aging with the OC Dept. of Social Services (DSS),
OC Health Dept.
Staffing: Student Intern
[Cost: Start-up-$200, Annual -None]
c2) Develop a funding plan for the provision of adult day services.
Lead Agency: OC Dept. on Aging, OC Dept. of Social Services, Health Dept.
and the NC Division of Aging (NCDOA)
Staffing: Student Intern
[Cost: Start-up-$300, Annual-None]
FY 2002-2003 Objectives -Goal III-A
c3) Implement an adult day (social & health) program through Orange County
Eldercare Services and the Orange County Dept. of Social. Services.
Lead agency: OC Dept. on Aging, Dept. of Social Services, OC Health Dept.
Staffing: TBD
[Cost: Start-up-$40,000, Annual -TBD]
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Central Orange Adult Day Health Center Initiative
Program Report
Submitted to
Orange County Board of Commissioners
May 20, 2003
By
Orange County Advisory Board on Aging
Florence Soltys, Chair
Jack Chestnut, Vice-Chair
Prepared by
The Department on Aging
Jerry M. Passmore, Director
5
Background
Establishing an adult day health program was one of the top priorities (Goal III-A, c1-3) of
the Master Aging Plan for Orange County approved by the County Commissioners on
March 6, 2001. In November, 2001, the Board of County Commissioners approved the
adult day health initiative and set aside $40,000 to plan and implement the adult day health
center. Apart-time planner was hired to direct the necessary planning and oversee the
renovation of the Meadowland's Drive site location in Hillsborough. Specific tasks that had
to be addressed before the doors could open were: facility design requirements, furniture
purchase, health and facility inspections, program policies, sliding fee schedule, funding
support, staffing contracts, marketing and networking, food and transportation service and
local and state certifications.
From the beginning, it was agreed that the Adult Day Health Center Initiative would be a
community partnership, not an on-going county program. Anon-profit agency would be
formed to take over the adult day health program as well as operate other programs
identified in the Master Aging Plan that serve the frail and disabled older adults.
The primary justification for such a program in the long term care continuum is that Orange
County did not have an adult day health program nor is there one in neighboring counties.
Secondly, the Master Aging Plan identified that:
(1) the increase of the senior population 60+ for Orange County will be over 128% by
2020, and over 235% of the 95+
(2) that more older adults are expressing a desire to remain 'in their homes -"Age in
Place" as long as possible;
(3) that caregiver are shouldering the burden of caregiving with little respite; and
(4) that an adult day program is a more cost-effective measure than other options along
the long-term care continuum.
The Program
The Adult Day Health Program provides social and health services to frail, disabled and
isolated older adults. Stimulating activities and enriching programs and nutritious meals
and snacks and rehabilitative services are all under one roof. The center will also provide
respite and education for the participant's families and caregivers, giving them amuch-
needed break and support from the responsibilities of caregiving,. These objectives serve
the main goal of the program, which is to prevent or delay the onset of institutionalization
of the participants.
The Adult Day Health Program is located next to the Central Orange Senior Center at 515
Meadowlands Drive, Hillsborough, N.C. It has 1,000 square feet of space and daily can
accommodate 10 full-day slots per day, or 20 half-day slots. This does not affect the
number of individuals that can be enrolled in the program, as some may elect to come
6
once a week, others may choose every day. The maximum service utilization would be
100 participants coming a half day once a week. As of May 1St, a month of operation, the
Center currently has 7 participants who attend on full and half day schedules.
The Adult Day Health Program was designed to serve all income levels of participants in
Orange County, not just those who can privately pay the full cost Hof the services. With this
in mind, the Orange County Advisory Board on Aging adopted a sliding fee schedule
(Attachment #1). To make up the difference for the actual program cost, the program
would draw down any federal/state funding reimbursements and offset the low
federal/state reimbursement rates with community partnership support. (Attachment #2)
To date, the average participant income is $890.00 per month. On the sliding fee scale,
this would generate a private pay of $11.00-13.00 per day, leaving a deficit of $52.00 per
day if there were no federal/state reimbursements.
Community/Funding Support
During the past year and half, several organizations stepped forward and committed their
support to the day health center initiative for FY 2002-2003: 1) Carol Woods has donated
over $18,400 for space rental and administrative costs; 2) Friends for the Senior Center in
Central Orange provided funds for utilities; 3) UNC School of Nursing provided contract
nursing services; 4) UNC Hospitals has donated $20,000 to supplement low income
participant payments which has allowed us to designate fees to participants on a sliding
scale; (5) Kerr Drug and Medical Supply Superstore provided medical and incontinence
supplies ($1000+) and (6) Local banks gave financial contributions -Central Carolina Bank
($250), and Hillsborough National Bank ($300).
In order to establish the Adult Day Health Center as a teaching model, several UNC Health
and professional schools (Social Work, Occupational Therapy, etc) have also agreed to
place students on an ongoing basis. This will help expand staffing and providing a "normal
aging" experience for students, rather than student placement in long term care facilities.
Renovations of Center Space
The renovation and furnishing of the Adult Day Health Center space began in the
November of 2001 and was completed by November of 2002. An Adult Day Health
Subcommittee, comprised of Advisory Board on Aging members and UNC faculty and
community residents, was formed to assist in this process. The renovations were from the
ground up, taking into account everything that would create a warm, safe and stimulating
environment. Student interns assisted in researching colors that would be most
appropriate for participants, especially those with dementia. All furniture was purchased
and designed for older adults who may need assistance, including power recliners, raised
couches and chairs with armrests. Specially designed toilets had to be installed, along
with awalk-in shower. A washer-dryer, tables, a day bed, stove and refrigerator were
donated by Carol Woods to reduce the upfit expense and the paint was paid for by the
Friends of the Senior Center.
Policies and Programming
The state standards for certification provide developing centers a blueprint for the types of
policies they need. The Central Orange Adult Day Health Center went above and beyond
these standards by creating policies that will deliver care which promotes independence
and self-care, maintains a participants' health and well-being and improves their quality of
life. The policies were formed with the input of social workers, physical therapists,
occupational therapists, nurses, and others with experience in the field of geriatrics and
adult day services. (Policies available)
The programming components, consisting of social, therapeutic and educational activities,
were developed with the cooperation of students dedicated to providing innovative and
progressive engagement of older adults. These were students and interns in such fields as
occupational therapy, nursing, and social work.
Staffing
Collaboration was key to establishing the highly qualified staff at the center. The
Department on Aging has contracted with the UNC School of Nursing who will provide a
Registered Nurse (RN) who can also supervise nursing students, giving them more
exposure and experience with the older adult population. The Department also has
contracted with Home Health Solutions, who will provide a nurse's assistant responsible
for the personal and health care needs required by some participants. Staffing
agreements with both agencies were signed, and all staff were hired and trained in
December, 2002.
Certification Process
With renovations, furnishings, policies and staffing in place, the center was due for its
certification process. This extensive process involved inspections by the County's Fire
Marshal, Building Inspections Division, and the State's Division of Environmental Health.
The Department of Social Services also designated an adult day specialist who conducts
an initial review of all the materials that make up the certification package (which contains
over 80 pages of documents). The Department of Health also reviews the health care
component of the center. When the package passed the county requirements, it was sent
to the State Division of Aging and a state inspector reviewed the package and the physical
environment itself, right down to measuring the square footage available to participants.
After extensive state program review and further modifications, the N.C. Division of Aging
issued a state adult day care operators license in March, 2003.
Participants Enrollment Process
Referrals for participants have been coming in from a variety of sources, including DSS's,
Adult Services, the Dept. on Aging's Eldercare Program, and those who have read about it
in papers or via word of mouth. Each enrollment begins with an in-home assessment by a
social worker and, if available, an RN. A medical history and medication list is obtained
from the potential participant's physician. These forms make up the initial framework of the
participant's chart. A nursing assessment soon follows and an individual plan of care is
developed for each participant.
With the staff, training, experience and supplies, the center is capable of caring for and
developing care plans to address a variety of medical conditions. To date, our participants
suffer from: dementia, stroke, diabetes, arthritis, incontinence, high blood pressure, heart
problems, and depression. They may also have a history of falls, malnourishment and
dehydration. It is these participants and others that are at-risk for long-term placement.
This is both a financial and emotional hardship. The decision to place a spouse or parent
in a long-term care facility can lead to feelings of anger, guilt and even depression. It can
also be an expensive option, draining family financial resources, as well as a state or
county's.
Cost Comparison: Day Centers vs. Other long-term care options.
Looking at the per day cost of services along the continuum of care, one can easily see
that adult day services are the most cost effective. Since most individuals prefer to live in
their own homes as long as possible, adult day services serve as the most favorable and
least restrictive option.
^ An average daily nursing home fee is $150 per day or higher.
^ An average daily assisted living rate can range from $100 for general care
up to $165 per day for dementia care.
^ An in-home aide from an agency costs about $150-180 per 10 hour day,
based on the current rate of home care agencies, which is $15.00 - $18.00
per hour.
The Central Orange Adult Day Health Center will cost $65.00 at its highest level of care for
10 hours of service. From there, the cost goes down depending on the individual's income
(See attachment #1). For that price, participants receive care, based on a nursing, social
work, and arecreational/social plan. The program is staffed with an MSW, an RN, and a
certified nursing assistant. Programming is designed to meet the needs and interests of
the participants, with an emphasis on developing relationships with other participants and
a sense of belonging to a community. Along with scheduled activities, participants receive
a luncheon meal, snacks, and transportation.
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Need for Continued Public-Private Support
Last year over 6 centers in North Carolina closed. Centers close often, due mostly to
financial woes. Adult day services receive low reimbursement, if any, from state and
federal programs. Medicare provides no reimbursement. Medicaid allocates $37.50 per
day in its Community Alternatives Program (CAP/DA). The State .Adult Day Care Fund
provides $23.07 for a participant attending for social care, and $30.00 for those requiring
medical care. The cost to provide the service per person per day is approximately $65.00.
The average monthly income of our participants is $890 (See attachment #2).
It seems evident that the Central Orange Adult Day Health Center is currently and will
most likely receive referrals from low and middle income residents of Orange County.
Consequently, charging participants the actual cost to provide the services would make
participation by low income individuals impossible. To restrict participation to those who
could afford $65 out-of-pocket on a daily basis excludes those caregivers who must work
during the day. The heavy financial burden of $1,365 per month for full price adult day care
would negate the financial gain of the caregiver's employment in many cases. Relying on
private pay participants only would create another option for well-to-do families who
already have the option of continuing care retirement communities like Carol Woods.
As we seek to develop a quality, affordable adult day care in Northern Orange County, we
can learn much from Charles House, a social adult day care program in Carrboro. Since it
opened, Charles House has never turned someone away due to inability to pay. Charles
House's reputation as a warm and loving community for seniors-especially those with
dementia has made it a county treasure. It has not gotten there overnight. Thirteen years
ago when it opened, there were 4 participants and 3 staff members. It took time, dedicated
staff marketing, creative programming, word of mouth, and most importantly, town, county,
and individual financial support, especially during its early development.
Relying on private pay participants with incomes in the area generally being lower in the
central and northern regions of the county, could jeopardize the financial future of the
center. With operating costs high and revenue and reimbursement low, the day center will
continue to need the community and County support, which would allow the center to
continue to serve those in need of some type of supervision to maintain their
independence and reside in their own homes, while providing relief and support for their
caregivers.
The Advisory Board on Aging Recommendations for FY2004
The Adult Day Health Center began operation March 28, 2003 once a food service
arrangement was reached with Classic Foods and delivery by OCIM volunteers. The
Advisory Board on Aging, with the Department on Aging staff, is now proceeding with
incorporation of anon-profit organization to assume program operation from the County
by January, 2004. The new non-profit structure would be based on the draft by-laws
10
submitted to the Board of County Commissioners in January, 2003. The Department on
Aging plans to prepare a continuation Adult Day Care budget for FY2003-04. The
Advisory Board on Aging has recommended maintaining a $40,000 county level funding
for FY2003-04 with a gradual reduction over time as federal/state reimbursement rates
increase to support low income participants, and as other community support is generated.
11
Central Orange Adult Day Health Center
Discount Fee Schedule
Medical Model Participant ($65 for full day)
Monthly Income Total Cost to Participant
i-,~r~.~~,~~~ai C:nimla % ~f Fee Paid Half day
Attachment #1
Full day
0-759 760-1015 0 $0/CAP eli ible $0/CAP eli ible
760-1065 1016-1442 20 $9.00 $13.00
1066-1215 1443-1646 30 $13.00 $20.00
1216-1359 1646-1839 40 $15.00 $26.00
1360-1516 1840-2052 50 $20.00 $33.00
1517-1666 2053-2255 60 $25.00 $39.00
1667-1816 2256-2459 75 $30.00 $49.00
1817 and u 2460 and u 100 $35.00 $65.00
Social Model Participant ($55 for full day)
Monthly Income
Individual Cou le % of Fee Paid
Total Cost to Participant
Half da Full da
0-759 760-1015 0 $0/CAP eli ible $0/CAP eli ible
760-1065 1016-1442 20 $7.00 $11.00
1066-1215 1443-1646 30 $10.00 $16.00
1216-1359 1646-1839 40 $12.00 $22.00
1360-1516 1840-2052 50 $15.00 $27.00
1517-1666 2053-2255 60 $20.00 $33.00
1667-1816 2256-2459 75 $25.00 $41.00
1817 and u 2460 and u 100 $30.00 $55.00
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Attachment #2
Central Orange Adult Day Health Center
Adult Day Health Operational Cost and Reimbursements Rates
as Compared to
Other Community based Services
Program Cost for Day Care
(provide 10-hour day of service
based on full enrollment)
$65.00/day per participant
Reimbursement Rates for Day Care $00.00 Medicare Program (Deficit-$65.00)
$40.00 Eldercare Program's C~~regiver Funds (Deficit-$25.00)
$37.50 Medicaid-CAP/DA -Health (Deficit-$25.50)
$30.00 State Adult Day Care Fund -Health (Deficit-$35.00)
$23.07 State Adult Day Care Fund -Social (Deficit-$31.93)
Average income of participants $890.00/month (sliding fee private pay-$11-13.00/day)
who have been referred to program
Other Comparative Community -based Service Rates
Nursing home (per day) $150.00
Assisted living (per day) $100.00 -$165.00 (depends on care level)
Home health agency Service $150.00- $180.00 (depends on agency/location)
(based on 10 hour/day)