North Carolina’s adult day centers are strapped for funding even though they allow some seniors and people with disabilities to keep living at home while giving caregivers some much-desired respite.
By Thomas Goldsmith
A retiree at 75, Melvin P. often rises in the morning to find the adult daughter he lives with has already left for work.
Jamaica-born Winston-Salem resident Melvin understands why he’s left alone by his daughter’s need to meet her needs as well as his. But the situation makes him appreciate his arrival at Williams Adult Day Center and the hours he gets to spend at the facility not far from Wake Forest Baptist Health.
Adult day care centers allow participants to continue living in the community and for Melvin to receive help with some daily activities. He also gets meals among a diverse group of people who have become his friends. A principal benefit of the service is that caregivers receive some hours of respite, or can continue employment.
But, the relatively small adult day sector took a deep hit when the COVID-19 pandemic forced centers to close for many months. The state’s centers were already under pressure because of a state-imposed cap on reimbursement.
Williams closed its door during the pandemic along with the rest of adult day centers across the state; only about half have reopened in recent weeks.
“I missed this place a lot,” Melvin said during a sunny spring morning back at the center. “When I left here, I’d go home, and it kind of gets boring.”
Adult day centers look after people at least 18 years old who may have dementia, intellectual disabilities, or residual symptoms of stroke. A care provider such as an adult child can drop off a participant on specific days of the week, allowing a break from the otherwise constant attention required to look after an aging parent, spouse or child who can’t stay alone for more than a few minutes at a time.
Many state and private care organizations faced closings and quarantines related to the pandemic. However, adult day care centers also had to deal with the effects of the singular state provision that caps the rates they can charge.
A bill at the legislature that has passed from the state House into a Senate committee would allow NC Area Agencies on Aging and county commissioners to make their own decisions on payments to adult day centers in their respective areas. However, overall state payments would not be boosted.
‘It has a lot of merit’
“The reimbursement rates have not kept pace with the true cost of service,” said Kristen S. Perry, chief operating officer of the Williams Center’s parent nonprofit organization, Senior Services Inc.
Along with Senior Services CEO Lee Covington, Perry is watching the bill in the North Carolina General Assembly.
“Based on what I know, I think it has a lot of merit,” Covington said. “The cost of providing the service has gone up. In different areas of the state, costs are different. It allows for that local flexibility.”
Local, state and federal funding, as well as some foundation and private-pay help support adult day care centers and the related service, called adult day health, for participants who need a higher level of medical care.
With a background of working for U.S. Sugar on his native soil, and as a cook and other jobs in the U.S., Melvin, like others at such centers, has a rich background in North Carolina and far beyond. At a nearby table sat Joine Z., 82, working a jigsaw puzzle with friends, her mind on the cobblestone streets in the overseas towns where she and her family once lived.
A choice before residential care
“My husband was in the military, the U.S. Army, and we lived in Germany and England,” she said. “My neighbors who were in the military, some of them, wouldn’t even come out of the house. They were afraid to go outside.
“My husband and I enjoyed it. I wasn’t afraid to go into the towns, like Kassel, in Germany. The people were very friendly.”
Joine told the same story of her family’s time overseas several times. A visitor, another resident and a staff member listened. No one interrupted her or pointed out her repetition. All were familiar with symptoms of dementia that most Williams Center participants possess to some degree.
For proponents of the funding changes, the key issue remains ensuring that facilities can remain in operation for people such as Melvin and Joine, whose husband still lives in their home. Some attendees might wind up in residential care were it not for the support these centers offer the participants and their caregivers.
A push to counteract waning services
Regarding the fee cap, some lawmakers at the General Assembly have asked whether paying more per participant would result in fewer people being covered overall.
During a May meeting of the House Health and Human Services Appropriations committee, Rep. Donna White (R-Clayton) addressed the question.
“If we don’t do something, we’re not going to serve any clients,” White said. “We only have 50 counties now with adult day care and adult day health care. We have lost 50 percent since 2020.
“The stakeholders tell us that if they could adjust the rates for reimbursement, then they would be able to keep it sound and we would stop losing facilities and we would be able to admit the people that need to be admitted.”