At the center of the bribery scandal that led to the arrest of Assemblyman Eric Stevenson last month is a pair of social adult day care centers. Indirectly funded through Medicaid, these facilities are popping up throughout the five boroughs. They are meant to serve frail and disabled elderly New Yorkers. But with virtually no government oversight, the current social adult day care system is putting vulnerable seniors -- and our tax dollars -- at risk.
Well-run social adult care centers play a critical role in helping seniors with chronic health problems, such as Alzheimer's and dementia, stay in their communities and avoid more costly forms of care. They offer important services that help participants stay active and provide desperately needed respite for caregivers.
However, unlike nursing homes, hospitals and other institutions that supervise the elderly, most of these programs are not regulated by the city or the state. Providers are not required to fill out an application or obtain a license to open a center. Facilities do not have to undergo inspections or provide staff training. There is no agency responsible for monitoring whether or not enrollees meet eligibility requirements, or if seniors are getting the services they need.
The social adult day care business is booming in this regulatory vacuum. Over the past two years, the number of centers in New York City has mushroomed from eight to nearly 200, and the growth has been particularly high in immigrant communities. Under the current system, managed care companies receive $3,800 in Medicaid funding per month for each person they enroll, and then pay adult day care providers to serve their clients. In turn, centers often refer new customers back to managed care plans.
According to New York State guidelines, seniors are only eligible for social adult day care if they require assistance with everyday tasks such as walking, eating or using the toilet. However, without government enforcement, managed care companies are left to decide who is eligible. And the more clients they enroll, the more profit health plans and day care providers stand to earn.
As a result, centers are launching aggressive marketing campaigns to lure new customers. Some have reportedly given cash and freebies to recruit healthy seniors who do not need adult day care service. The competition for clients is so fierce that four providers allegedly paid Assemblyman Stevenson $20,000 to write a bill that would prevent new centers from being built in the five boroughs.
New York needs to do more to ensure that impaired seniors are receiving appropriate services and that Medicaid money is being spent wisely. Facilities should be required to offer services including client supervision, meals, and assistance with personal care. They should have to create individualized plans for each participant and train staff on elder care issues. In addition, client assessments should be mandated to guarantee that participants meet eligibility standards, and can benefit from programs.
With New York City's aging population expected to double over the next 20 years, social adult day care can and should play an important role in our health system. But first, we must rein in this Wild West-like industry before we lose control altogether. With proper oversight and accountability, adult day care centers have the potential to reduce costs and provide vital services that improve the quality of life for seniors.
Council Member Jessica Lappin is Chair of the New York City Council Aging Committee. Council Member Maria del Carmen Arroyo is Chair of the New York City Council Health Committee.
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