Adult Day Care Center for Alzheimer's Patients Reached Breakeven A Year Ahead of Schedule
From 1993 to 1995, Nevins Family of Services expanded its existing adult day health services by opening an Alzheimer's Adult Day Care Center in Methuen, Mass. It center also achieved financial self-sufficiency.
The project was part of the Robert Wood Johnson Foundation (RWJF) Partners in Caregiving: The Dementia Services Program national program.
- The center provided day care six days a week to the more than 26 adult sufferers of mild to moderate dementia who were enrolled by the third year of the grant.
- Project staff developed family training programs and caregiver support groups.
- The center reached financial breakeven by the end of its third year, a year ahead of schedule.
RWJF supported this project through a grant of $93,918.
The Nevins Family of Services opened in 1906 with a not-for-profit rest home on an 11-acre campus in Methuen, Mass. Until 1976, it provided rest home and nursing home care for approximately 80 residents. In the mid-1970s, Nevins began offering adult day services on its campus for up to 24 additional clients.
A second adult day site was opened in 1984 in neighboring Andover, Mass. In 1988, the original adult day center relocated to a new building on the Nevins campus, with space for 60 clients and for a preschool and kindergarten. Nevins operates a transportation service with eight vehicles that serve its own and other ambulatory and wheelchair clients.
With this grant, The Nevins Alzheimer's Adult Day Care Center, designed exclusively for persons suffering with dementia, opened in 1993. It was initially housed in rather cramped space within the existing Nevins Adult Day Health Center on its campus in Methuen, Mass. A year later the adult day center relocated to a new building of the same campus, adjacent to the Nevins nursing home. The center is open six days per week, providing care from 7:30 a.m. to 5:30 p.m. weekdays, and 8 a.m. to 4 p.m. on Saturday. Its enrollment was jump-started by the transfer of clients suffering from Alzheimer's from Nevins' existing adult day health center.
Since its inception, enrollments at the center have exceeded projections. During years two and three of the grant period, it served an average of 26.5 adults per day, and 45 families per month. Its Saturday program averages 13 clients. The center achieved financial self-sufficiency in year two of the project, a year ahead of schedule. Staff believed self-sufficiency resulted from the following factors:
- A local market that responded to the program, particularly to its health components.
- Aggressive efforts by the director to start offering visiting nurse services for families needing support for the member with Alzheimer's (to assist families with the bathing, dressing, etc.).
- The good reputation of the Nevins organization.
- The continued evolution of state policy which increasingly restricts nursing home access, thus requiring families to seek community day care providers, such as the center.
Marketing the center. Nevins promoted the opening of its Nevins Alzheimer Adult Day Care center with a 1993 ceremony that featured actress Shelley Fabares, a board member of the National Alzheimer's Association. The opening was attended by more than 100 guests, and articles on the opening appeared in local newspapers. Center staff spoke, whenever asked, at local meetings. The center developed two newsletters one for families and another for professionals that were mailed to more than 600 individuals and organizations. It also distributed fact-sheets, Rolodex cards, and key rings all with information promoting the program and the center.
Fees-for-service and matching funds. From the beginning, the center charged a daily fee that reflected its full expenses: private pay clients were charged $7 an hour for care and public-pay clients were charged a rate of $32.41 for a six-hour day (with additional hours billed separately). Transportation, showers, and other ancillary services were billed separately. In 1995, Nevins negotiated higher reimbursement rates from the state's home care corporations. During the grant period the center secured $47,000 in matching funds from local and national foundations.
Implementing in-home companion care. An in-home companion care program opened seven months after the center opened. Project staff found they were unable to handle both the center startup and this in-home care program simultaneously. The companion program involved intensive screening and training of aides available for part-time work.
The program offered three categories of service: hourly, 24-hour, and 1.5-hour blocks in the morning and evening to assist with wake-up and bedtime activities. The latter "up and tuck" service was not as heavily used as staff anticipated, although thoroughly marketed by the center and the Nevins organization. Its use by the end of the grant period, in 1995, totaled approximately 150 hours per month. Staff concluded that the families of Alzheimer's suffers could not afford both day care and this assisted caregiving at the beginning and end of the day when behavioral issues are most frequent and, given the choice, tended to favor the day services.
Nevins successfully dealt with the program's ebb and flow in demand by using a scheduling mechanism that integrated in-home companion staff into its day center staff. Initially, the center also intended to provide showers for clients. Staff quickly recognized that it was more efficient to arrange this service through the local Visiting Nurses Association, which already assisted some clients with showers in their own homes.
Professional and family training and support groups. The center developed family and professional training programs throughout the grant period. Shortly after it opened in 1993, the center gave a series of four seminars on Alzheimer's care to 150 caregivers and professionals. Responding to community interest, largely from clients' families, the center also began an Alzheimer's caregiver support group that met monthly, and later weekly, attended by between 5 and 15 caregivers. The center also gave educational workshops that provided educational credits to more than 50 social workers and members of several Visiting Nurses Associations. Family training sessions on hospice contracts and home and care management were offered four times during the grant period. Because of the demand for these programs, the local Area Agency on Aging provided the financial support for Nevins to offer a fifth family training program in 1995. Through its connections with area social agencies, Nevins also became an educator in home management and care planning for caregivers.
Clients' transportation not a problem. Unlike other national program sites, Nevins did not face a significant challenge with clients' transportation because the parent organization included a transportation service with eight vans. Additional transportation needs were met through standby contracts with local taxi companies.
The communications effort is described in the preceding section on marketing.
AFTER THE GRANT
At the grant's conclusion, Nevins intended to increase private pay rates in order to enhance the center's financial self-sufficiency.
GRANT DETAILS & CONTACT INFORMATION
Alzheimer's Adult Day Care Center in Methuen, Massachusetts: Partners in Caregiving
The Nevins Family of Services (Methuen, MA)
Dates: June 1993 to May 1995
Report prepared by: Rona Smyth Henry
Report prepared by: Nancy J. Cox
Report prepared by: Burton V. Reifler
Report prepared by: Carolyn Asbury
Report prepared by: Karin Gillespie
Reviewed by: James Wood
Reviewed by: Molly McKaughan
Program Officer: Rosemary Gibson
Program Officer: Rona Smyth Henry