Monday, November 9, 2009

What does $40,000 per year actually get for you in the world of adult day care?

Ever consider how much it actually costs, per person, to house 95 or 100 adults, in what is usually a cramped adult day services center, for an afternoon of card playing, radio listening, television watching, or just general sleeping and meandering?

Ever wonder just where that $40k per year that you, your insurance company, or medicaid pays to provide adult day care to you or our loved one actually goes?

If you or your loved one doesn't attend The Golden Years, the answer is most likely that it does not go directly toward the care of intended registrants.

The overwhelming majority of adult day service centers in America will provide our seniors and other developmentally disabled adults with a clean, generic, institutional-like atmosphere where they can participate in several rigidly structured daily events. Until now, the simple fact that anyone was available to provide ANY services to this large and oft ignored population demographic was considered by those who required them, for themselves or for a loved one, to be a Godsend - and they were!

Nobody can ever really understand the life of a caregiver until life happens and places you in the never expected and truly unfortunate situation to be one. Once there, the idea of a respite, even an extremely brief one, might seem the only thing standing between you and insanity. For these caregivers, the idea of a clean place where their loved ones might go for a few hours a day to be safe and in proximity to others who are similarly afflicted seemed too good to be true.

Today, adult day service centers (or adult day care centers as they are frequently referred) are relatively common in most parts of the country and most people have either had a family member who has attended one, or known someone who has. Traditionally, such centers have done an admirable job of providing quality care, supervision, and companionship to seniors and the developmentally disabled adults they were designed to accommodate. As such, I want to go on record right now as saying that I would never, for even a minute, try to suggest that the majority of such establishments don't truly care for the registrants that attend their facilities and work admirably and diligently to provide a very high level of care and supervision. What I am saying, however, is that good intentions and basic supervision simply shouldn't be enough anymore.

When I envisioned The Golden Years prototype, I didn't envision building a new mousetrap, just building a much better one.

After coping with my mother's increasingly debilitating illnesses for over ten years, and enrolling her in one of the better adult day care centers on Long Island, I had occasion to visit my mother while she was at the complex. What I found was a very antiseptic environment. The multi-purpose rooms I saw were clean and efficient in the extreme, but devoid of emotion, laughter or good nature. Supervision and attentiveness of staff were in high abundance, but completely missing were joy, autonomy or independence of any kind. My mother had come to enjoy her time there and even to look forward to going each day, while it was all I could do to keep from bursting out in tears at the sight of the place as my mind's eye could see the 50 or so registrants I observed that day, and in the days that followed, visually wasting away before my eyes and in real-time.

Once I got home, I began to look through my mother's medicaid billing records to see just how much such an endeavor was costing the taxpayers of America, and I was appalled to discover that it cost just under $40k per year ($39,644 to be exact) for my mother to attend this facility 6 days per week, from 9:00am to 2:30pm, 6 days per week. Yes, this amount did also include the cost of her transportation to and from the facility, but she was certainly not the only passenger on the route either. The gravity of what I had seen that day was then immediately compounded by the incredible amount of money this seemed to me to be. While this amount might seem plausible to you when considering an individual, the actual costs get far more watered down when you consider a registration and attendance base of about 100 people per day.

If this facility was earning just under $40k per year, per registrant, I wanted to know what that equated per day, per registrant, so that I could calculate the approximate daily, weekly, monthly, and annual gross revenue of the facility as a whole. I will spare you the calculations since they are easy enough to do on your own, but as you can see if you did the math, the complex earns approximately $128.00 per registrant, per day. When multiplied by 100 registrants, this totals $12,800 per day (5.5 hours); $76,800 per week (6 days); $332,800 per month (26 days); and a whopping $3,993,600 per year (305 days since you also have to account for the facility being closed on Sundays and the 8 major bank and federal holidays).

Could I possibly conceive of a way to accommodate at least 100 senior or afflicted people in a way that would give them a significantly greater amount of freedom, and independence in how they spent their days while at my facility?

What could I do with a $4,000,000.00 per year budget that this place, and places like it weren't already doing? Could I really provide more choices, more autonomy in the daily schedules of those non-dementia patrons who still enjoyed active lifestyles but just sought some companionship and camaraderie?

I could.... and The Golden Years concept was born.

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