Centering On Care
There are about 35 to 40 clients who regularly join Harold Fisher and Marvin Wolfson at Pikesville. That number can vary from day to day, depending on a client’s needs, funding and personal schedule. Client population for each center is based on square footage, and a staffing ratio must be maintained of at least one professional to seven clients.
In Maryland, centers are licensed to serve anywhere from 35 to 250 clients at a time. (While Renaissance is licensed for more, its average attendance hovers around 150.) Regulations are extremely consistent and exacting across the state and closely monitored by the Department of Health and Mental Hygiene, said Jeff Wright, a board member at the National Adult Day Services Association (NADSA). Nationwide, regulation for adult day centers differs greatly; some states have no regulations at all.
“Because Medicaid is the primary payer, each state is allowed to set whatever governing requirement they like,” said Wright, who consults centers across the country in all aspects of regulation and management.
Wright’s organization recently hired its first lobbyist, and its members are coordinating an Adult Day Services Advocacy Day on Capitol Hill in April; about 20 states will be represented. The organization, like the industry, is growing.
There are 112 medical adult day centers in Maryland, compared with 280 in California and 400 in Texas.
“Maryland chose to apply to the Center for Medicaid and Medicare Services for a waiver program to provide for adult day services,” said Wright. “So now CMS wants to make sure someone is looking closely at what is required for someone to get into the program and how [the centers] are providing and assessing care.”
Government funding and coverage for adult day services can get complicated. Medicaid will cover adult day services due to the nursing home waiver the state of Maryland applied for and now holds, but Medicare will not. Part of NADSA’s lobbying is to help change that coverage ability.
“One big push is to get Congress to get Medicare to cover it, which would allow some federal guidelines to be upheld across the country,” said Wright.
Marianne Meighen, president of the Maryland Association of Adult Day Services, echoed the need to both simplify and secure more methods of funding for adult day services.
“One of the changes we’re seeing is for more culturally diverse [adult] day care,” said Meighen. “Some are dealing with Persian, Asian and Russian communities; we’re seeing more of them. And they’re really catering to the people they’re servicing.”
The Pikesville and Levindale centers are examples of that specialization. They provide kosher meals for their clients and commemorate Jewish holidays, and the centers receive regular visits from Rabbi Jeffrey Orkin of Lifebridge Health. Renaissance Adult Medical Center, catering to its Jewish Eastern European clients, has created what appears to be a cultural haven.
David Yusupov, president of Renaissance, arrived in 1980 from Baku, Azerbaijan. He opened his first adult day facility in 2002 in Baltimore. All seniors were welcome, irrespective of cultural background or language, but it unintentionally and quickly became a Korean culture facility due to its location and the population attending the center. Its success prompted a second Korean center nearby.
Today, Yusupov is president of five centers in the Baltimore area. All are open and accessible to qualifying seniors regardless of language or ethnicity.
It wasn’t until the Russian population in Baltimore began aging that Yusupov saw a need and the Renaissance Center was opened.
“We have senior centers all over Pikesville, and we see our [Russian] seniors aging,” said Renaissance program director Marina Sokolin. “So the thought process was: Where are they going to go? We’re the children, we’re working; who is going to take care of them?”
Elsewhere, adult day centers specialize in care for Alzheimer’s and advanced dementia; others care for primarily chronically ill clients, said Meighen. The Snyder Center for Aphasia Life Enhancement, for instance, is located on York Road in Baltimore.
Aphasia is the loss of ability to understand or express speech caused by brain damage often due to stroke. SCALE’s care focuses on the needs of the population affected by the disease. According to its website, it provides individuals with aphasia a place to connect and offers interactive group
activities designed to support and empower members as they re-engage in community. It provides educational materials, training and support for family members as well.
Keswick Adult Day Services in Roland Park specializes in care for people with Alzheimer’s who wish to remain in their homes and communities. In addition to assessment, monitoring and medical care services for its clients, Keswick also provides specialized rehabilitation therapies for Alzheimer’s clients.
As with so many trends, the baby boomer generation has affected trends in long-term medical health care. Ferretto works with a lot of baby boomers, and she is one herself.
“One thing I see with the boomers is that not only are they giving it all they can to take care of their parents, but they’re also thinking about what they want to do for themselves when they get older in terms of things that their parents didn’t do, like long-term-care insurance or putting in place their advance directives,” said Ferretto.
Boomers are experiencing a different scenario than their own parents, because the older generation didn’t typically provide care for aging parents living with chronic illnesses, she related. “So it’s been a change in all the dynamics.”
Ferretto is a proponent of adult day services when appropriate for a client. She said it’s a quality service that can keep people functioning at their highest possible level as long as possible. For many, especially those with dementia, it provides a level of stimulation and socialization unavailable in other settings. It also provides family caregivers breathing room.
Adult day services “give them respite … they have some time off,” said Ferretto. “The caregiver is so important. … I always tell [them], if you’re not well, your loved one isn’t well; so while your loved one is in the day program, you have the opportunity to do what you need to do, whether it’s work and not worry or just have a day off to go out with a friend.
“It’s a win-win,” she surmised. “Everybody wins, the caregiver and the loved one.”