FEATURE: Dr. Merle Griff: Adult Day Health an Overlooked Part of the Care Continuum

Copyright 8.26.2014: Scientific Cowboys – Nancy C Everitt, PMP

Editor’s Note: The below interview features Merle D Griff, PhD, CEO SarahCare Adult Day Care, a leading authority on adult day health. In April of this year, I had the distinct opportunity to spend several hours with Dr. Griff discussing the SarahCare model and achieve a better understanding of the gap in the care continuum surrounding the use of adult day health  or lack thereof for many patients.

An unfortunate reality is that when there is a gap in knowledge or the process is difficult (real or perceived) barriers emerge.  In this article we will seek to break some barriers as we garner insights from Dr. Griff along with a baseline on adult day health and best practices that can assist patients, providers and plans in outcome gains.

Adult Day Care/Health Defined:

According to the National Adult Day Services Association, there are approximately 4600 adult day care facilities nation-wide (National Adult Day Services Association, 2010).  Not all adult day care centers are licensed and regulated; this varies by state and size of facility. There are two prevailing models 1) adult day care social model and 2) adult day health medical model.   In this article we will focus primarily on licensed, medical model adult day health centers. A patient receives social interaction, meals and varying levels of care at an adult day health center. A patient can attend daily, as needed or on a defined schedule generally for a half or full day.

QUESTION: Dr. Griff, Adult Day Health is not a first solution for discharge planners and care managers who generally turn to Home Health, Home Care or a facility based solution.

According to data provided by the Genworth Cost of Care Survey in 2012 of the various care options, ADH is cost effective (Genworth Financial, Inc., 2012):

  • Adult Day Health: median ($2,010 per month)
  • Home Health ($4,560 a month per an 8 hour day)
  • Assisted Living Facility ($3,300 per month)
  • Skilled Nursing Facility Semi private room ($6,000 per month)

What are your thoughts?  Is it reticence or lack of familiarity impacting the use of Adult Day Health in discharge planning? NCE

ANSWER MDG: “There are significant reasons why many discharge planners do not utilize the comprehensive services of an adult day health center.

1)      Utilization of home and community based services (HCBS) requires coordination of multiple services with the family’s schedule and between agencies. Although this is ultimately the family’s responsibility they often are not aware of the services available, have difficulty understanding the service offerings including which services are appropriate for their family members and possible funding sources.

2)       Discharge planners are often not aware that adult day health centers can offer case management services in which they will coordinate with a MCO, Area Agency on Aging, or a Geriatric Care Manager that facilitates the individual’s ability to return to their home and to their family. Some adult day health centers, such as SarahCare®, will send a nurse or social worker into the hospital in order to begin working with the family and the discharge planner prior to their discharge. The goal is to provide a seamless transition from hospital to home.

3)      There is concern about violating the individual’s homebound status. However, a federal regulation, passed in 2002, allows people to maintain their homebound status while attending a medical model adult day center. This exception does not apply to social models who do not provide nursing services.”

QUESTION: How can Adult Day Health help with potentially preventable readmissions? NCE

ANSWER MDG: “The nurses, both RNs and LPNs, and the nursing and activity assistants are in an optimal position to closely monitor the health of the participant. Some research studies have shown that a nurse calling a patient once a week has had a significant effect on factors such as medication compliance.

In the adult day health centers the professional staff closely observes not only the condition of the patient on a more regular basis but in many cases also that of the family caregiver. They are available to intervene earlier through actions such as assisting families in handling medication organization and compliance. Also, they can closely monitor key factors that often result in readmission such as fluid intake/output and thus recognize the early signs of dehydration.

As participants are getting out of their homes, they experience less cognitive decline and confusion resulting from problems with reality orientation. They also experience less depression being in a safe and supportive setting where they can be with friends, participate in activities, and have fun.

Especially for those who live alone the adult day health center insures that they have sufficient nutrition by providing breakfast, lunch, and snacks.”

QUESTION: Let’s talk outcomes; can you share any specific studies or outcomes that would be helpful in ADH program evaluation? NCE

ANSWER MDG: A study conducted by Parma hospital in Ohio showed that their patients who were discharged from the hospital and attended their adult day health center experienced significantly reduced readmission rates.  [Link to Parma Hospital Study]

QUESTION: Any closing thoughts on the overall benefits of Adult Day Health? NCE

ANSWER MDG: “ An adult day health center allows family caregivers to either stay in their own homes and rest or take care of necessary errands or enjoy being with friends and family. This respite extends their ability to continue caring for their loved one.

For every person enrolled in an adult day health center, two people get back their lives; the participant and the caregiver.

Being part of the energy in a center proves that life doesn’t end with a diagnosis. “


About Merle Griff, PhD:

Merle D. Griff, Ph.D., a gerontologist with twenty years experience, is one of the leading authorities on adult day care in the U.S. She is the past Chairperson of NADSA (National Adult Day Services Association). She has been a delegate to the last two White House Conferences on Aging. She founded SarahCare© when she could not find the care she wanted for the families she worked with professionally and for her own aging mother as a loving daughter. Her desire to provide families with better care spurred her to create and develop SarahCare© Adult Day Centers.

About the Author:

Nancy C. Everitt, MBA is the President and CEO of HEOPS, Inc. and Editor in Chief of Scientific Cowboys. Ms. Everitt is lead strategist to Clients’ on the design and fulfillment of patient access solutions such as network development and provider engagement, quality analytics, Medicare Advantage STARS strategy, disruption analysis and mapping. Ms. Everitt has been involved in the strategy of each engagement and provides significant perspective on industry best practice.

In addition to serving as Editor in Chief on Scientific Cowboys, Ms. Everitt is a frequent contributing writer to the publication sharing real world advice and operational insights on process and performance improvement. Questions on this article may be addressed directly to neveritt@heops.com.



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