Public Policy Agenda

Facilitate Access to Adult Day Services

More than a quarter million participants (273,200) were enrolled in an estimated 4,800 adult day centers operating in the United States on any given day according to the National Study of Long Term Care Providers recently published by the National Center for Health Statistics[1].  Adult Day Services center participants are more diverse than users of other major long-term care services with respect to race, ethnicity and age and 32% had a diagnosis of Alzheimer’s disease or other dementia.[2] Although the majority of participants are elderly, 37% of adult day services consumers were under age 65, supporting previous research on the increasing role of these centers in serving younger persons with intellectual and developmental disabilities and the growing numbers of veterans with traumatic brain injuries.[3]  People living with chronic conditions and diseases such as hypertension, physical disability, cardiovascular disease, diabetes, mental illness, dementia, developmental disability, or traumatic brain injury need better access to adult day centers so they can receive the care they need to avoid the high costs of institutionalization by living in their own homes.   NADSA’s member volunteers in every state are working with our public officials to resolve challenges in the following policy areas to ensure that access to Adult Day Services is included in all long-term care services and supports (LTSS) policy decisions.                                     

Modernize Veteran Access to Adult Day Services

 Many of our returning military veterans who need Adult Day Services to remain at home with their families find that because of outdated, overly burdensome administrative requirements, the Veterans Administration (VA) is unable to contract with Adult Day Service centers near the veterans’ homes. As a result, wounded warriors and their families are often faced with either institutionalization (which may also be a long distance from their home) or grueling long distance trips for Adult Day Service. The VA has devised regulations to allow it to follow the same provider agreement requirements as approved by the Centers for Medicare and Medicaid Services (CMS) but it needs legislative authority to do so.   Co-sponsor and support prompt passage of S.739 or H.R.1369 (bi-partisan companion bills) to modernize the manner in which the VA may issue provider agreements for adult day services and other long-term extend care to veterans. [1] Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services in the United States: 2013 overview. Hyattsville, MD: National Center for Health Statistics. [2] Centers for Disease Control and Prevention, NCHS Data Brief Number 164, September 2014 [3] Ibid.  

Modernize Medicare to Achieve Cost Avoidance  

During the past half-century, Medicare services have been expanded but the system itself has not been modernized to accommodate less expensive delivery of services to consumers with chronic diseases. Adult Day Health Centers (ADHC) provide quality, cost-effective nursing services, physical therapy, occupational therapy, and social work services. NADSA encourages Congress and CMS to infuse health care funding with consumer choice for more cost-effective home and community-based services through an ADHC.  Offering rehabilitation through ADHC to individuals discharged from acute care institutions rather than re-institutionalizing them in a nursing home is more cost effective and more therapeutic.   Support H.R. 1383 The Medicare Adult Day Services Act or a similar Senate Bill to modernize Medicare with Adult Day Services for cost avoidance.

Modernize Access for Seniors to Adult Day Services  

In the words of Senator Chuck Grassley (R-IA), “Today, the federal government does not pay for long-term services and supports unless an individual is poor enough to be on Medicaid. What frequently happens is that seniors on Medicare [who are not poor enough to qualify for Medicaid] go into a nursing home, spend down their assets and then go on Medicaid for their long-term care. These seniors don’t want to be in an institution and they don’t want to be on Medicaid. But that is what the system forces upon them…One estimate shows four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization [with an option to utilize adult day services or other home and community based services].”   Co-sponsor and support S. 704 introduced by Senators Grassley & Cardin.

Reauthorize the Older Americans Act (OAA)

Initially enacted in 1965 together with Medicare and Medicaid, the OAA was the first attempt by the federal government to provide comprehensive assistance to seniors. With 10,000 baby boomers turning 65 every day, states depend upon OAA funds for senior programs. A portion of the OAA funds provide access for consumers to choose home and community-based Adult Day Services to help them to remain in their homes with their families in lieu of being admitted to a nursing home. S. 192 has been introduced and reported from committee with bi-partisan support to reauthorize the OAA.   Support S. 192 to reauthorize the Older Americans Act to facilitate consumer choice of Adult Day Services to avoid more costly institutional admissions.