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Medicare would pay for adult day
care under pilot program
Associated
Press
By NANCY ZUCKERBROD, Associated Press
Writer
WASHINGTON (AP, July 21) - Patricia
Smith of Louisville, Ky., has relied on Medicare to
pay for home nursing care in the past, but she now gets additional
attention at an adult day-care center -- an option that soon might
be more widely available to older
Americans.
State Medicaid programs pick up the
day-care tab for low-income people such as Smith in some parts of
the country, while others generally pay for the service themselves.
But legislation pending in Congress
would add Medicare to the mix, allowing
beneficiaries eligible for the program's homebound coverage to use
that benefit instead for day care.
Smith, 69, who has suffered from
a stroke and breast cancer in recent years, said she
prefers day care over in-home assistance because of the social benefits.
"You intermingle with people. You're not by yourself,"
said Smith, who added that she
became depressed while stuck at home after her stroke. Those eligible
for Medicare's in-home benefit would qualify for day-care coverage
under a pilot program included in legislation recently passed by
Congress.
"It gives seniors another choice,"
said Sen. Jim Bunning, R-Ky., a lead supporter of the
change. A recent study funded by the Robert Wood Johnson Foundation
found about 2,100 adult day-care centers nationwide that provided
elderly and disabled people with medical assistance.
About 80 percent of centers that
participated in the survey reported being licensed or
certified by states. More than 70 percent are run by nonprofits,
and the average age of users is 72. Meals are usually provided,
and activities range from art classes to field
trips and even wheelchair exercises.
The day-care component of the Medicare
legislation has no known opposition and even the support of an industry
group representing in-home nurses. The legislation could ease problems
associated with a nursing shortage and doesn't threaten the in-home
nursing industry, said William Dombi, a lobbyist for the National
Association for Home Care and Hospice.
"I don't think everybody that
is a Medicare homebound patient is a candidate for adult
day services," he said, noting that some patients can't leave
their beds and others
prefer to stay home.
The legislation's main supporters
say their proposal will save Medicare money because
group care is more economical than in-home services. It generally
costs about $90 for a nurse to visit a patient at home, compared
with about $60 per day to treat, entertain and feed the person in
day care, said Bill Yarmuth, chief executive of Almost Family, a
Louisville-based company that runs both an in-home
nursing business and adult day-care centers. Yarmuth said day-care
facilities may see costs rise when they start routinely caring for
patients so sick they're eligible for Medicare's homebound benefit.
But he said day care will still be cheaper than home care because
nurses can see more people in a day if they don't have to travel.
Among the biggest supporters of the proposed benefit are relatives
of those who benefit.
"We've had great experiences
with home health, but they were in and out," said Julie
Smith, Patricia's daughter. "Leaving her alone was the scary
part."
The House and Senate bills are slightly different. The House version,
sponsored by Rep. Ron Lewis, R-Ky., would establish the pilot program
in five states. The Senate measure, offered by Sen. Rick Santorum,
R-Pa., would allow the demonstration to take place at three centers.
A joint committee will meet to settle the differences.
Both bills call on federal officials to analyze the pilot projects
and determine if the
benefit should be made nationwide.
Patricia Smith said she enjoys day
care so much she can't believe her daughter initially
had to push her to try it. "I told her, 'No. I will just stay
here and sleep and watch soap operas,'" Smith recalled. "Now,
I wouldn't do that for nothing in the whole world."
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