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Demand for adult day care rises with aging population: Joy's House, other local facilities expecting growth

February 4, 2008

Joy's House on Broad Ripple Avenue provides day care services for 23 people. Often at or near capacity, the not-for-profit is raising funds to build a $1.6 million addition that will quadruple its current size.

The cramped quarters, where activities include shooting balls in pint-size basketball hoops, underscores the need for extra space. And the participants are not children; they're adults-the parents of baby boomers who've been thrust into the role of care giver.

Adult day care centers steadily are becoming a more affordable alternative to nursing homes and home health programs for those seeking care for elderly parents unable to stay at home alone. Many, like Joy's House, are experiencing growth.

For Michele Stuart, Joy's House is a safe haven for her 79-year-old mother, Bobbi Stuart, while she's at work.

"I feel secure, because I don't have concerns that she'll walk off," said Stuart, whose mom has been living with her for three years. "That puts me at ease."

National data on adult day care is murky, because states define adult day care centers differently. But the number of centers in the United States likely tops 3,500, said Peter Notarstefano, director of home and community-based services at the American Association of Homes & Services for the Aging in Washington, D.C.

In central Indiana, roughly 25 such centers are operating, ranging from social models that have no nurse on staff, such as Joy's House, to medical providers that do.

Active Day Corp. is a medical adult-day company whose entrance into the local market should push the numbers higher. The Baltimore-based company absorbed two Alliance Adult Day Services locations in Indianapolis and plans to open a third by summer.

Founded in 1995, Active Day has opened 57 sites in seven states and is targeting up to 100 by 2010, company President and CEO Chris Balcock said.

The growth of Active Day, coinciding with the emergence of the Canton, Ohiobased Sarah Adult Day Services Inc. franchise, emphasizes the demand for adult day care on a national level.

It's a trend expected to gain momentum, considering the 65-plus population will reach 70 million by 2030, more than double the number in 2000, according to the U.S. Department of Health and Human Services.

"The next generation of older adults is going to look at adult day care and say, 'Wow! This is really affordable to me,'" said Notarstefano at the AAHSA.

Still a quiet industry

Indeed, the national average cost for adult day care is about $61 a day. Tina McIntosh, who founded Joy's House in 2000, charges $60 for a full day and $35 for a half day. The average hourly rate for a home health aide is $19, or $152 for an eight-hour day.

Bingo, trivia and crossword puzzles, as well as stretching, pilates and aerobics, are part of the regimen at Joy's House, meant to stimulate mental and physical activity. The day ends at 5:30 p.m. following an hour of refreshments and snacks.

The 3,000-square-foot, 100-year-old house hardly can contain the two dozen seniors and 12 employees, including six administrators who are shoehorned into two offices upstairs.

The expansion, which should start by summer, will increase space to 12,000 square feet. The two-story addition will feature two large activity rooms, more office space and rest rooms, and a bigger basement for storage.

Most critical, however, is the opportunity to accommodate more guests. Yet, for all the strides made, the industry still is a novelty to most, McIntosh said.

"Adult day service is where child care was in the '70s," she said. "It's just not very well-known."

Most centers originated in the past 20 years from bingo games and bag lunches in church basements. Catholic Charities Indianapolis, for instance, founded A Caring Place at Fairview Presbyterian Church on Capitol Avenue in 1990, although a previous program dates to 1982.

A Caring Place can oversee 22 people and is nearly full most days, said Lula Baxter, director of Catholic Charities' adult day care program. The center employs both a nurse and physical therapist and, on occasion, treats seniors to field trips to the Indiana State Museum or Conner Prairie.

Barbara Wade, a housekeeping supervisor at The Westin Hotel Indianapolis, has taken her 80-year-old mother, Ella Woodard-Johnson, to A Caring Place for four years. For relief from the around-theclock care she and her husband provide, Wade even takes her on her days off.

"I notice that when she's home on the weekend, especially if it's a three-day weekend, she gets a little antsy, just like a little kid," Wade said. "You have to keep her busy."

Indiana attractive to providers

Besides an aging population, another factor fueling adult day care is better Medicaid reimbursements. Private pay remains the most popular option, but third-party reimbursements from Medicaid, Area Agencies on Aging and the Veterans Administration are becoming more attractive.

In fact, government officials in Indiana adjusted reimbursement rates July 1 to encourage providers to come to the state. The reason in particular is to shift some of the expenses from more costly nursing homes and home health care.

Forty-five adult day-care providers are enrolled in the state's Medicaid waiver program, including three that have registered since the changes occurred, according to the state Family and Social Services Administration.

The change in policy attracted Active Day to Indiana. In addition to the two centers it absorbed in Indianapolis, the company also acquired an Alliance Adult Day Services location in Munster. Further, it is construct-Wayne. In all, Active Day should have seven locations in Indiana by next year. Still, demand outstrips supply. As of ing a facility, in Muncie, that should open

in March and plans to open two others in

Lafayette and either South Bend or Fort 2003, the most recent year data was available, Indiana needed 119 new centers, according to a study by the Robert Wood Johnson Foundation in Princeton, N.J.

States generally require that centers be registered or licensed. While abuses may occur, complaints are minimal, Notarstefano at the AAHSA said, because the providers are dedicated and typically depend on community funds for support.

In the case of Joy's House, corporations and foundations contribute to its $610,000 annual budget. That's a huge amount when reflecting on the home's humble beginnings. It started with one client who came half-days three times a week.

"When I look back, McIntosh said, "I don't know how in the world we did it."
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