Chapter VII.

Adult Day Services: Information and Resources

Overview of Adult Day Services

Adult day services are community-based group programs designed to provide social, and in some cases, health services, to adults who need supervised care in a safe place during the day. In addition to serving an older adult or person with disabilities, adult day services afford caregivers a break from their demanding responsibilities.

Adult day centers typically operate during normal business hours, five days a week. A few programs offer services in the evenings and on weekends. Although each center may differ in terms of features, services offered by most adult day centers include:

Social activities, often defined as interaction with other participants in planned activities appropriate for their age and/or abilities.
Personal care that entails help with activities of daily living, such as going to the toilet, walking, and eating.
Therapeutic activities such as exercise and mental interaction for all participants.
Meals and snacks.

In general, there are three types of adult day centers:

1. Social adult day centers that provide meals, recreation and some personal care services.

2. Medical/health adult day centers that provide more intensive health and therapeutic services, such as some nursing and physical therapy, in addition to social activities.

3. Specialized adult day centers that only serve specific care recipients, such as those with diagnosed dementias or developmental disabilities.

Some material from this section came from information provided by the National Adult Day Service Association whose website is www.nadsa.org/adsfacts/default.asp/.

Regulations of Adult Day Services

There are no state licensing requirements for adult day services, nor is there any oversight for adult day service programs that serve only clients who pay out of their own pockets.

Some adult day services centers have chosen to serve clients whose care is paid for by the Medicaid Waiver or the CHOICE programs. If this is the case, the center must meet “Provision and Certification Standards” set by the Indiana Family and Social Services Administration (FSSA). To learn what these standards are, go to: Adult Day Service Provider Packet.

Client Rights

Because adult day services are not regulated in Indiana, there are no specific rights afforded to adult day services' clients. Check any contract or agreement you have with the center to see what rights your loved one has.

If your loved one’s care is funded through Medicaid Waiver or CHOICE, his or her rights include:

Privacy.
Confidentiality of records.
Freedom from neglect.
Freedom from sexual, physical, emotional, financial and mental abuse.
Freedom from physical or chemical restraints used for the purposes of discipline or convenience and not required to treat the participant’s medical symptoms.

Listing of Adult Day Services Centers

For adult day services centers in Marion and the seven surrounding counties, go to: www.cicoa.org/IA/PDF/AdultDayCare.pdf/.

The Indiana Association of Adult Day Services provides a list of centers throughout the state that are members of their association. To access their list, go to: www.iaads.net/Find_A_Center.html/.

You can also contact the Area Agency on Aging for the region in which your loved one lives.

Checklists and Guides For Choosing an Adult Day Services Center

Shopping for an Adult Day Center

Selecting Quality Providers

What to Look for When Choosing an Adult Day Care

Adult Day Care Checklist

Adult Day Centers

Costs and Payments

Costs

In 2008, the average cost of adult day services in Indiana was $77 per day. In the Indianapolis area, the average cost was $81.*

* Source: MetLife Market Survey of Adult Day Services & Home Care Costs. September 2008.

Payment

Adult day services can be paid for by:

1. Medicaid Waiver

Federal law requires Medicaid to pay for long term care services only when they are delivered in a nursing home or other long term care facility. However, states may negotiate a "waiver" of that requirement in order to provide a full array of home and community based long term care services. To qualify for Medicaid Waiver services, a person must be eligible for Medicaid, and in need of the same level of care as those who qualify for Medicaid nursing home care. Eligibility for a Waiver is based on an in-home assessment done by a care manager from the local Area Agency on Aging, and then reviewed by a state Medicaid case manager.

There are a number of different kinds of waivers. The most common waiver for older adults is known as the Aged and Disabled Waiver. To access Medicaid Waiver services, you must work with your local Area Agency on Aging (AAA). For more information read this Consumer Waiver Guide provided by the Indiana Governor's Council for People with Disabilities.

2. CHOICE

CHOICE is Indiana’s state funded home care program. Any cost to the individual is based on a sliding fee scale—referred to as a "cost share." To qualify for CHOICE funding you must be limited in at least two activities of daily living. A person seeking services funded by the CHOICE program must also work with their local Area Agency on Aging (AAA). The process starts with an in-home assessment conducted by the AAA care manager from that person's local agency. Once a person is screened and their home care needs are determined, the AAA case manager works with the person and his or her family to design a care plan that is tailored to meet the person’s specific home care needs within the bounds of available funding. Care voluntarily provided by family members, friends, neighbors, and local service organizations is incorporated into the care plan in order to maintain their involvement and to control costs. People of any age may apply to enter the CHOICE program. For more information on CHOICE, click here.

3. Long Term Care Insurance

Long term care insurance policies cover long term care expenses once an individual has met a pre-defined set of qualifying criteria. Depending on the policy, adult day services may be covered. Long term care insurance is not for everyone, and it is very important that consumers carefully evaluate the pros and cons and their own financial situation before purchasing a policy. One evaluation tool available to consumers is “The 2007 Self-Assessment Guide for Long Term Care Insurance,” which is produced by the Indiana Long Term Care Insurance Program. That guide, and "The Buyer's Guide to Long-Term Care Insurance," are useful resources for anyone looking into long term care insurance.

4. Veterans Aid and Attendance Benefit

The Aid and Attendance Pension Program provides financial assistance to a qualifying veteran, veteran and one dependent, or a surviving spouse. This benefit can cover adult day services. To qualify, a veteran must be eligible for a VA pension, meet service requirements, meet certain disability requirements, and meet income and asset limitations. Aid and attendance is paid in addition to a veteran’s basic pension. It can take up to six months to process an application, so starting early is important. For more information, go to: www.veteranaid.org/.

5. Private pay

Your loved one (or someone else) pays for the service out of their own pocket.

Getting Good Care For a Loved One

The following are tips to help you get quality adult day services (in no particular order):

1. Educate yourself. Learn what you have the right to expect. You can learn what the adult day center is supposed to provide to your loved one by:

Asking to review a copy of the center’s policies and procedures.
Reading any contract or agreement to learn about the center’s responsibilities and your loved one’s rights and responsibilities.

If your loved one’s care is paid for by Medicaid Waiver or CHOICE, familiarize yourself with:

The Adult Day Services standards/guidelines.
The statement of consumer rights, which must be provided to your loved one by the center.

2. Share information about your loved one with staff.

The more staff know about your loved one, the better job they can do of helping your loved one have a good day at the center. Make sure you tell staff about likes/dislikes, what distresses your loved one, what calms him or her down, approaches that work, etc. It’s a good idea to write down the information and give it to staff in addition to talking with them. Ask the center team what information they need from you to help them create a good experience for your loved one.

3. Participate in determining the care and services to be provided to your loved one.

In some adult day services centers, there is a process in which a care plan is created for the participant. In general, the care plan (which may be called something different) describes a person’s needs and what services the center will provide to meet those needs.

The center must develop an “individual care plan” for your loved one if his or her adult day services are paid for by Medicaid Waiver or CHOICE. This plan has to be reviewed by the Area Agency on Aging care manager and updated at least every 90 days or more often if there are changes in your loved one’s condition or a change in the services your loved one needs or wants. Some centers create care plans for all individuals, not just those funded by Medicaid Waiver or CHOICE.

Tips for participating in the care planning process

(if a formal care plan is to be developed).

Ask when the care plan will be developed or reviewed. Inform staff that you wish to participate if it is all right with your loved one or if you have the legal authority. Involve your loved one in this process too, if he or she wants to take part.
Request that the staff person who knows your loved one the best participate as well. If this is not possible, ask that this staff person provide input. A staff person familiar with your loved one will be able to contribute important information about how your loved one is doing and what care approaches are most successful.
Prepare for the discussion by identifying questions and any concerns in advance. Make a list so you remember the points.
Speak up at the meeting!! Don’t be shy! Support your loved one!
Get a copy of the plan once it has been created or revised.

If your loved one’s center does not create a formal care plan, ask staff how they determine what service and assistance will be provided to your loved one and inform them that you wish to participate in whatever process they have.

4. Ask that the same caregivers be assigned to care for your loved one most of the time. This is called consistent assignment and can improve your loved one's quality of care.

5. Monitor care and services.

Once you know what care and services are to be provided, monitor to make sure your loved one receives that care.

You can monitor by:

Talking with your loved one.
Asking staff how your loved one is doing.
Observing your loved one. Visit occasionally and at different times to see how your loved one is getting along, how staff interacts with your loved one, and whether the services and help your loved one is receiving correspond to what staff said they would provide.
Reviewing records (if you have the legal authority). Look for:
- Information about your loved one’s condition, progress and status. If you find notes indicating a change that has not been brought to your attention, request that you be notified of any future changes.
- Any problems you are not aware of and what is being done about the problems.
- Whether your loved one is getting the care and services outlined in the care plan or that staff told you would be provided.

6. Develop a positive working relationship with staff.

Get to know staff.
Treat staff with respect.
Show appreciation for good work. A "thank you" means a lot.

7. Communicate effectively!

Find out the name of the person at the adult day services center whom you should contact and the best time to do so when you have information to share or questions to ask.
Keep center staff updated on any changes in your loved one’s condition or medication.
Leave emergency contact information with your phone number(s) and that of another family member/friend (if possible).
State what you mean clearly, politely, respectfully and in language that is free of blame and judgment. Speak up nicely, if something isn’t done, or if it isn’t done the right way. How you communicate is just as important as what you communicate.
Reinforce positives. Thank staff when a problem has been addressed or when good care has been provided.

8. Keep a journal.

Make notes about:

Your observations.
Your loved one’s condition and appearance after spending time at the center.
Any change in your loved one’s condition or incidents involving him or her.
Any problems. Write down when the problem occurred, the people involved, what happened, where it happened, and indicate what staff said they would do about the problem. Include staff names if you know them.

9. Connect with other families.

If possible, get to know the family members of other adult day services' participants. Becoming acquainted with other families gives you the opportunity to compare notes about how things are going and to join together if there is a problem affecting not only your loved one, but other participants as well.

10. Take action when there is a problem!

The sooner you address a concern, the better—problems that go unaddressed can build up over time and can become more difficult to resolve. Don’t be afraid to ask questions or voice concerns with the supervisor or center director if you feel your loved one’s needs are not being met.

Addressing Problems

Listed below are some approaches that you can take to address a problem with care or services provided by an adult day services center (these steps do not have to be followed in this order).

Before trying to resolve a problem, check with your loved one, if possible, to make sure he or she wants action to be taken. In addition, try to involve your loved one as much as you can in problem resolution.

Working with the adult day services center to resolve the problem

1. Speak with staff.

Start by discussing the problem with the staff that are most directly involved to see if the problem can be corrected. If that is not successful, speak with a supervisor, if there is one, or with the center director. Take notes about your conversation.

2. Use the center’s grievance or complaint resolution process, if there is one.

Ask what the center’s process is for voicing a concern. If your loved one is a CHOICE or Medicaid Waiver client, the center must provide you with a description of the complaint resolution process in the consumer contract.

3. Put your complaint in writing and request a written response.

4. Request a meeting to discuss your concerns.

5. Go up the “chain of command” if talking to the center director does not resolve the problem.

For non-profit centers, communicate with the president of the board. If the center is for-profit, contact the owner, a regional director, or even the CEO.

General Tips for Voicing Concerns

Make sure you have details about the concern, such as the nature of the problem, when it occurs/occurred, and names of people involved.
Report concerns and problems to staff as soon as they arise.
Clearly state your concerns and the outcome you would like; state what you mean clearly, politely, respectfully and in language that is free of blame and judgment.
Document your conversations with staff about the problem. Make copies of anything you submit in writing. Keep any letters you receive.

For guidance on communicating with and presenting a problem to staff, see:

Seeking help outside the adult day services center

If one or a combination of the approaches listed above does not resolve the problem, there are organizations, agencies and programs you can turn to for help outside the adult day services center.

1. Consult a private geriatric care manager or your loved one’s CHOICE or Medicaid Waiver care manager.

Care managers can help resolve problems. A private geriatric care manager is usually either a nurse or a social worker and brings knowledge and expertise to the problem. Geriatric care managers charge a fee for their services and most will also bill for out-of-pocket expenses (mileage, long-distance calls, etc.). To learn more about private geriatric care managers and get a list of geriatric care managers in Indiana go to: caremanager.findlocation.com/.

If your services are funded through the Medicaid Waiver or CHOICE programs, you can ask your care manager to help solve the problem. The care manager can work with you and the agency to reach a solution.

2. File a complaint with the Indiana Division of Aging.

If your loved one’s services are funded through Medicaid Waiver or CHOICE and working with the AAA or other care manager has not resolved the problem, contact the Division of Aging to report the problem.

Division of Aging

402 W. Washington Street

P.O. Box 7083, MS21

Indianapolis, IN 46207-7083

317-232-7132 or 800-545-7763, ext. 2-7132
www.in.gov/fssa/2329.htm

Other Resources for Complaint Resolution

Adult Protective Services (APS)

Adult Protective Services investigators investigate reports of abuse, neglect or exploitation of endangered adults 18 years or older. If you do not know the address of your local APS investigator, you can contact the state office.

Adult Protective Services

Indiana Division of Aging

402 West Washington Street

P.O. Box 7083 MS 21

Indianapolis, IN 46207-7083

317-232-0135 or 800-992-6978
www.in.gov/fssa/da/3479.htm

Law Enforcement Agencies

Should you believe that your loved one has been the victim of a crime while at the adult day service center, contact a local law enforcement agency immediately.

Licensing Boards

There are a variety of boards that license health professionals such as nurses and physical therapists. These boards also investigate complaints filed against these health care professionals. To file a complaint, you must submit a complaint form. To get a copy of the form, call 800-382-5516 or 317-232-6330 or go to:

www.in.gov/attorneygeneral/consumer/onlineform.html/.

Mail the form to:

Consumer Protection Division

Office of the Indiana Attorney General

302 W. Washington St., 5th Floor

Indianapolis, IN 46204

Legal Assistance

Elder Law Firms

Private attorneys can often help resolve a problem or assist you in seeking compensation and justice if your loved one has been harmed or neglected in an adult day service center.

“Elder law” attorneys may be of particular assistance in resolving a concern since they focus their practice on issues frequently confronted by older adults and their families. In Indiana, certain attorneys have been certified as specialists in Elder Law. To locate an elder law attorney in your area, go to: www.naela.org/MemberDirectory/.

Indiana Legal Services, Inc.

Indiana Legal Services provides free assistance to those who meet certain financial criteria. For more information and to locate an office, go to: www.indianajustice.org/Home/PublicWeb/LegalSvcs/.

Appeals Process: For CHOICE/Medicaid Waiver Clients Only

If your concern is related to a decision about services, there is an appeal process you can use to challenge the decision. Decisions that can be appealed include: your loved one being found ineligible for services, having services denied to your loved one; having services discontinued, or having services provided to your loved one that are not in his or her best interests. To learn more about appealing a decision about CHOICE in Marion and the 7 surrounding counties, see “Appeal Process for Client Services.” If your loved one lives outside of that area, contact his or her local AAA (see Chapter IV). For information about how to appeal a Medicaid Waiver decision, read “Your Appeal Right as an Applicant for HCBS Benefits.”

>>>Click here for VIII. Assisted Living: Information & Resources

Caregiver Digest: A Guide to Indiana Long-Term Care Resources

Chapter VII.

Table of Contents

Chapter VII.

Adult Day Services: Information and Resources

Overview of Adult Day Services

Adult day centers typically operate during normal business hours, five days a week. A few programs offer services in the evenings and on weekends. Although each center may differ in terms of features, services offered by most adult day centers include:

Social activities, often defined as interaction with other participants in planned activities appropriate for their age and/or abilities.

Personal care that entails help with activities of daily living, such as going to the toilet, walking, and eating.

Therapeutic activities such as exercise and mental interaction for all participants.

Meals and snacks.

In general, there are three types of adult day centers:

1. Social adult day centers that provide meals, recreation and some personal care services.

2. Medical/health adult day centers that provide more intensive health and therapeutic services, such as some nursing and physical therapy, in addition to social activities.

3. Specialized adult day centers that only serve specific care recipients, such as those with diagnosed dementias or developmental disabilities.

Regulations of Adult Day Services

There are no state licensing requirements for adult day services, nor is there any oversight for adult day service programs that serve only clients who pay out of their own pockets.

Client Rights

Because adult day services are not regulated in Indiana, there are no specific rights afforded to adult day services' clients. Check any contract or agreement you have with the center to see what rights your loved one has.

If your loved one’s care is funded through Medicaid Waiver or CHOICE, his or her rights include:

Privacy.

Confidentiality of records.

Freedom from neglect.

Freedom from sexual, physical, emotional, financial and mental abuse.

Freedom from physical or chemical restraints used for the purposes of discipline or convenience and not required to treat the participant’s medical symptoms.

Listing of Adult Day Services Centers

For adult day services centers in Marion and the seven surrounding counties, go to: www.cicoa.org/IA/PDF/AdultDayCare.pdf/.

The Indiana Association of Adult Day Services provides a list of centers throughout the state that are members of their association. To access their list, go to: www.iaads.net/Find_A_Center.html/.

You can also contact the Area Agency on Aging for the region in which your loved one lives.

Checklists and Guides For Choosing an Adult Day Services Center

Shopping for an Adult Day Center

Selecting Quality Providers

What to Look for When Choosing an Adult Day Care

Adult Day Care Checklist

Adult Day Centers

Costs and Payments

Costs

In 2008, the average cost of adult day services in Indiana was $77 per day. In the Indianapolis area, the average cost was $81.*

Payment

Adult day services can be paid for by:

1. Medicaid Waiver

2. CHOICE

3. Long Term Care Insurance

4. Veterans Aid and Attendance Benefit

5. Private pay

Your loved one (or someone else) pays for the service out of their own pocket.

Getting Good Care For a Loved One

The following are tips to help you get quality adult day services (in no particular order):

1. Educate yourself. Learn what you have the right to expect. You can learn what the adult day center is supposed to provide to your loved one by:

Asking to review a copy of the center’s policies and procedures.

Reading any contract or agreement to learn about the center’s responsibilities and your loved one’s rights and responsibilities.

If your loved one’s care is paid for by Medicaid Waiver or CHOICE, familiarize yourself with:

The Adult Day Services standards/guidelines.

The statement of consumer rights, which must be provided to your loved one by the center.

2. Share information about your loved one with staff.

3. Participate in determining the care and services to be provided to your loved one.

In some adult day services centers, there is a process in which a care plan is created for the participant. In general, the care plan (which may be called something different) describes a person’s needs and what services the center will provide to meet those needs.

Tips for participating in the care planning process

(if a formal care plan is to be developed).

Ask when the care plan will be developed or reviewed. Inform staff that you wish to participate if it is all right with your loved one or if you have the legal authority. Involve your loved one in this process too, if he or she wants to take part.

Prepare for the discussion by identifying questions and any concerns in advance. Make a list so you remember the points.

Speak up at the meeting!! Don’t be shy! Support your loved one!

Get a copy of the plan once it has been created or revised.

If your loved one’s center does not create a formal care plan, ask staff how they determine what service and assistance will be provided to your loved one and inform them that you wish to participate in whatever process they have.

4. Ask that the same caregivers be assigned to care for your loved one most of the time. This is called consistent assignment and can improve your loved one's quality of care. 5. Monitor care and services.

Once you know what care and services are to be provided, monitor to make sure your loved one receives that care.

You can monitor by:

Talking with your loved one.

Asking staff how your loved one is doing.

Observing your loved one. Visit occasionally and at different times to see how your loved one is getting along, how staff interacts with your loved one, and whether the services and help your loved one is receiving correspond to what staff said they would provide.

Reviewing records (if you have the legal authority). Look for:

Information about your loved one’s condition, progress and status. If you find notes indicating a change that has not been brought to your attention, request that you be notified of any future changes.

Any problems you are not aware of and what is being done about the problems.

Whether your loved one is getting the care and services outlined in the care plan or that staff told you would be provided.

6. Develop a positive working relationship with staff.

Get to know staff.

Treat staff with respect.

Show appreciation for good work. A "thank you" means a lot.

7. Communicate effectively!

Find out the name of the person at the adult day services center whom you should contact and the best time to do so when you have information to share or questions to ask.

4. Ask that the same caregivers be assigned to care for your loved one most of the time. This is called consistent assignment and can improve your loved one's quality of care.

5. Monitor care and services.