Public Policy Agenda

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Facilitate Access to Adult Day Services

People living with chronic conditions and diseases such as hypertension, physical disability, cardiovascular disease, diabetes, mental illness, Alzheimer’s, dementia, developmental disability, or traumatic brain injury need better access to adult day centers to receive the care they need to continue to live in their own homes and avoid the high costs of institutionalization.

More than a quarter million consumers (273,200) were enrolled in an estimated 4,800 adult day centers operating in the United States on any given day according to a 2013 National Study of Long Term Care Providers published by the National Center for Health Statistics[1].  A follow-up 2014 study revealed that Adult Day Services center participants are more diverse than users of other major long-term care services with respect to race, ethnicity and age. Additionally, 32% had a diagnosis of Alzheimer’s disease or other dementia.[2]

The same 2014 study noted although a majority of participants were elderly, 37% of adult day services consumers were under age 65. In short, Adult Day Services centers increasingly are serving younger persons with intellectual and developmental disabilities and a growing number of veterans with traumatic brain injuries.[3]

NADSA member volunteers from every state are working with our public officials to ensure that access to Adult Day Services is included in all long-term care services and supports (LTSS) policy discussions and decisions.

[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]  

Protect Medicaid Funding for Adult Day Services

Medicare and Medicaid increasingly have been under attack from various members of Congress.  Now, however, as never before in the history of these programs, the repeal or replacement of the Affordable Care Act (ACA) threatens the Medicare trust fund and Medicaid services for the elderly and disabled, leaving some of our nation’s most vulnerable populations at risk.  NADSA encourages Congress to not only protect Medicare and Medicaid at its current levels but to consider increasing support to provide more citizens with access to Adult Day Services. Remind Congress that Medicaid is the payor of last resort and pays nearly 2.5 times more per-person for nursing home care than for ADS in lieu of nursing home care.

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). NADSA encourages Congress to provide funding to all veterans in need of Adult Day Services. (NADSA has been advised that these bills of the past session will be reintroduced and we will provide the links at that time.)

In 2016 the House approved legislation directing the VA to initiate agreements with state veteran homes specifically to provide ADHC services to eligible veterans. The intent of the sponsors is to allow the veteran homes to provide space on their property for ADHC services or to utilize existing nearby ADHCs. Urge co-sponsorship and passage of H.R.1005 or S.324. Both are bi-partisan bills

Click here to Read about House Passage of H.R. 1005

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].”   Urge co-sponsorship and passage of S.309 introduced by Senators Chuck Grassley (R-IA) and Ben Cardin (D-MD).

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 an ADHC to individuals discharged from acute care institutions rather than re-institutionalizing them in a nursing home is more cost effective and more therapeutic. Legislation has been introduced in multiple sessions to provide ADHC services as an option to institutional care. NADSA is actively seeking a method by which to move it forward before it is reintroduced again. The President’s call, using our words, to Modernize Medicare may provide us with an opportunity.

Please continue to contact members of Congress to let them know that we support healthcare that protects the elderly, our veterans and America’s most vulnerable populations.