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This Way In: Covering Adult Day Care

Stump, Elizabeth

doi: 10.1097/01.NNN.0000361351.46144.4f
Department: the Waiting Room

Be an Advocate Visit the National Adult Day Services Association at for links to the bill and sample letters for e-mailing your representatives in Congress in support of H.R. 3043.

Earl, a 72-year-man with Parkinson's disease, falls while trying to put the dishes away and breaks a hip. He enters the hospital, undergoes hip-replacement surgery, and recovers enough to return home with rehabilitation services. His 63-year-old wife, Sandra, is still working and wants to continue to work, but she's worried about leaving Earl home alone. Currently, their only options as Medicare beneficiaries are to receive skilled rehabilitation services at home (utilizing a Medicare Certified Home Health Agency) or move into a skilled nursing facility for rehab, according to Beth Meyer-Arnold, chair of the National Adult Day Services Association.



The new bill will help keep patients in the home longer and give caregivers the option to keep working.

However, if the Medicare Adult Day Care Services Act (H.R. 3043) is passed, Earl and others with dementia or another disability who qualify for home health care would have the new option of living at home while receiving nursing services, therapy, meals, fellowship, learning, and recreation at a nearby adult day care center. Caregivers like Sandra could continue to work outside the home during the day, with an eight-hour respite from caregiving duties.

The Medicare Adult Day Care Services Act, introduced to the House of Representatives on June 25 by Congresswoman Linda Sánchez (D-CA), extends coverage to seniors, people with disabilities, and their families. Under the bill, Medicare would pay adult day care providers 98 percent of the rate for home health care.

Since caregivers who take unpaid leave to provide care and coordination of services typically lose an average of $659,139 in wages, pension benefits, and Social Security benefits over a lifetime, says Rep. Sanchez, the bill helps protect income for family caregivers. Additionally, it does not add to the cost of Medicare, and it provides patients with more services and longer hours of care for a lower, all-inclusive rate.

Fifty-two percent of the people using adult day care center services nationwide have some cognitive impairment, says Meyer-Arnold. With so many neurology patients who would potentially benefit from H.R. 3043, it should come as no surprise that the American Academy of Neurology (which publishes this magazine) backs the legislation. The Academy's Government Relations Committee and Academy President Dr. Griggs sent a letter to the House of Representatives in support of the bill, says Daniel C. Potts, M.D., a neurologist at Alabama Neurology and Sleep Medicine, P.C., assistant professor of neurology at the University of Alabama School of Medicine in Tuscaloosa, AL, and the 2008 Palatucci Advocacy Leadership Forum Advocate of the Year.

“The American Academy of Neurology (AAN) realizes that this bill has the potential to provide great benefits to our patients and their caregivers at a time when the aging of the population looms as a huge challenge,” explains Dr. Potts. “In addition, because this bill will create greater choice under Medicare, and will result in overall cost savings for the health care system by keeping patients in the home longer and giving caregivers the option to remain in the workplace, I think the AAN sees this as an important aspect of the overall health care reform effort.”

Dr. Potts, who was responsible for bringing the bill to the AAN's attention, notes that the creation and support of adult day care has been his main advocacy goal since beginning his advocacy work for the AAN. “Since my experience as an Alzheimer's caregiver, I have been strongly motivated to take actions to improve the lives of dementia patients and their caregivers, and to create respite opportunities for caregivers as well,” he says. “My father had a life-changing experience at Caring Days, a dementia day care center like the ones alluded to in the bill, in Tuscaloosa, AL. Its program of cognitive stimulation, including art and music therapy, helped stabilize my dad's condition, preserve human dignity and sense of self worth, and gave my mother respite.”

Dr. Potts's father was a client at Caring Days Adult Daycare Center until about a year prior to his death in September 2007, where he created about 90 original watercolors in the center's art therapy program. (Visit the day care center at to view a collection of his art, titled The Broken Jar.)

In addition to the AAN, a handful of other associations—the National Adult Day Services Association, the National Council on Aging, and the Alzheimer's Foundation of America, among others—have endorsed the legislation crafted by Rep. Sanchez and the American Association of Homes and Services for the Aging.

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At press time, H.R. 3043 has six bipartisan cosponsors: Rep. Charles A. Gonzalez (D-TX), Rep. Sheila Jackson-Lee (D-TX), Rep. James P. McGovern (D - MA), Rep. Ron Paul (R - TX), Rep. Albio Sires (D-NJ), and Rep. Donald M. Payne (D-NJ).

Dr. Potts encourages patients and caregivers to contact their members of Congress and ask for them to cosponsor or support H.R. 3043, write letters of support to Ways and Means Chairman Rangel, and raise awareness in the community and among other patients for the bill. (See box, “Be an Advocate.”)

Similar versions of this legislation have been introduced in prior sessions of Congress, notes Rep. Sanchez. But she says that she is hopeful that the major health care overhaul Congress is working on this year will be the “right time” for the adoption of the adult day care legislation.

The bill will not be in the House health reform bill and most likely will not be in the Senate health reform bill either. Instead, it will be offered as a stand-alone or attached to another health-related vehicle later in the year.

“I plan to continue to advocate for the bill's passage because it is good for patients, their families, and American taxpayers,” says Rep. Sanchez.

Elizabeth Stump

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