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Daycare For Grownups

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 daycare 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 daycare 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 daycare 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 daycare 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 daycare 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."

By Nancy Zuckerbrod

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