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HomeMy WebLinkAbout8.2 Informational Report on Adult Day Services ProgramsAgenda Item 8.2 it STAFF REPORT DUBLIN CITY COUNCIL CALIFORNIA DATE: February 7, 2023 TO: Honorable Mayor and City Councilmembers FROM: Linda Smith, City Manager SU B.ECT: Informational Report on Adult Day Services Programs Prepared by: Jordan Foss, Management Analyst II, Judy Miller, Management Analystll, Jennifer Mendez, Management Analyst I,, Rhonda Franklin, Management Analyst II EXECUTIVE SUMMARY: The City Council will receive an informational report on Adult Day Services programs, including an overview of their structures, regulations, and local program examples. STAFF RECOMMENDATION: Receive the report and provide direction, as necessary. FINANCIAL IMPACT: None. DESCRIPTION: This item is in response to an April 5, 2022, Item 9 request for information regarding establishing an adult day-care/senior day-care program and using ARPA funding on the program. Background According to the California Department of Aging, Adult Day Services programs offer an alternative to nursing home care for those who do not need 24-hour skilled nursing. The programs are designed to help adults and seniors stay mentally and physically active while reducing their isolation and improving their overall health, both mentally and physically. Adult Day Services are provided in two types of licensed settings, Adult Day Programs (ADP) and Community -Based Adult Services (CBAS).1 Both services offer out -of -home care for elderly and 1 Community Based Adult Services if formerly known as Adult Day Health Care Page 1 of 5 107 younger adults in community -based centers. Participants in either ADP or CBAS programs attend centers in their communities based on individual need, which can be between two to five times a week, for up to eight hours a day. While centers operate as day programs, some centers offer extended hours to accommodate working caregivers. All programs either provide or assist with transportation arrangements. ADP offer day -time programs for adults through a non -medical model of care and are licensed by the California Department of Social Services (DSS) Community Care Licensing Division. Trained aides provide structured activities, meals, monitoring services, and protective supervision for individuals who require additional care than typically provided at a senior or community center. In addition, these ADP often provide caregiver support groups and training. These programs are funded through private payments, Veteran's Administration benefits, Area Agencies on Aging, and Regional Centers (if the participant has a developmental disability). CBAS offer Adult Day Health Care programs in a medical model to Medi-Cal beneficiaries and must meet strict eligibility requirements as set by the California Department of Public Health and Department of Aging. CBAS programs serve older and younger adults with chronic disabling medical, cognitive, or mental conditions that put them at risk of being institutionalized. Coordinated teams of licensed professionals provide organized day programs focusing on health, therapeutic, and social services. CBAS programs utilize teams of nurses, social workers, and physical, speech, and occupational therapists to focus on preventive, social, and medical care to benefit clients who are deemed high cost/high risk patients. CBAS programs are funded through Medicaid and the State General Fund. Centers also accept Medi-Cal, Managed Health Plans, Veteran's Association, or Long -Term Care insurances. State Regulation Considerations DSS mandates staffing ratios and position requirements for all Adult Day Services programs. In general, the staffing ratio is either one direct care staff person to four adults, or one direct care staff person to eight adults, depending on the participants' need for assistance with activities of daily living. Staffing requirements would also be based on the type of services provided, including administration, nutrition, nursing, activities and social services, and operations (housekeeping, cooking, maintenance, transportation, etc.) as well as the size of the program space. Staff are subject to training requirements which include orientations, initial training, and continuing education requirements. The facility would also be subject to monitoring and annual inspections by the licensing agency, with stipulations for unannounced visits. Establishing an ADP requires applicants to complete a three -component process that consists of an attendance at a pre -application orientation, application submission and review by DSS, and category -specific training in areas not often understood by new licensees. Generally, the application requires basic contact information as well as more detailed financial and operating plans including the maximum number of persons to be served by the program, the categories of persons to be served including persons with developmental disabilities, mental disorders, or physical handicaps, and its hours or periods of operation. Similarly, the State Department of Public Health regulates CBAS programs and requires each provider receives a Medi-Cal certification. The State Department of Agency must also conduct a Page 2 of 5 108 financial review as well as onsite medical and management reviews, pursuant to Health and Safety Code 14573, prior to receiving the Medi-Cal certification. CBAS Standards of participation require facilities to have space sufficient to accommodate both indoor and outdoor activities, a multi -purpose room large enough for all participants to get together for large group activities and for meals, and a secluded area that is set aside for participants who require bed rest and for privacy during medical treatments or social service interventions. Furthermore, CBAS must staff a registered nurse for every 40 participants and who must be present in the center during program hours. Program aides/nursing assistants shall be staffed at one per 16 participants. Local Program Examples In preparation of this item, Staff conducted a cursory review of ADPs and CBAS throughout the Bay Area to better understand any anticipated start-up capital and operating costs, as well as staffing and usage levels. While most entities were unwilling to provide this information, the section below summarizes information available to staff. Bay Area Community Services (Oakland) Prior to the COVID-19 pandemic, the City of Oakland partnered with Bay Area Community Services (BACS) to offer Adult Day Care programs to seniors with Alzheimer's and dementia at the North Oakland Senior Center. Under this arrangement, the City provided a facility equipped with a kitchen, restrooms, and program space. BACS managed the program, including licensing, staffing, enrollments, social services, and administrative and legal requirements. Funding for this program primarily came from reduced participant program fees, the City did not provide funding as part of the arrangement. BACS ended the program during the early onset of the pandemic as BACS' organizational priorities shifted away from providing these services and maintaining state licensing became too onerous. Choice in Aging (Pleasant Hill; Brentwood) The Choice in Aging (CiA) program centers administer Adult Day Programs and Community Based Adult Services, serving participants from Contra Costa, Solano and Napa Counties. CiA is planning to build a new $52M Aging in Place Campus in Pleasant Hill. The campus will include a senior affordable housing component, space for an adult day health care program (including memory case), and a Montessori preschool with intergenerational programming for children and seniors. The City of Pleasant Hill is contributing $2.7M to the project from their Housing Asset Fund, which is estimated to be completed in 2024. Silicon Valley Adult Day Health Care Center (Milpitas) The Silicon Valley Adult Day Health Care Center provides services to about 80 clients per day. They have daily activities that include a variety of physical exercise and mental stimulation programs such as dancing and Mahjong. They are licensed to provide developmentally disabled services to assist in acquiring and maintaining life skills for independent living. The Center provides round-trip transportation to and from clients' homes. A staff of approximately 25 (both full- and part-time) includes at least one registered nurse and a social worker. Programs and operations are funded from Medi-Cal and state support. Page 3 of 5 109 Grace Adult Day Health Care Center (Santa Clara) Grace Adult Day Health Care Center location in Santa Clara provides a full range of elderly health care, rehabilitative, social services, balanced meals, and transportation to approximately 70 daily clients. The center operates with a range of 17 - 45 full-time staff with an estimated monthly cost of $200,000 - $280,000 based on varying participant enrollments and program activity. Medi-Cal may cover the entire program cost to eligible participants. Golden Castle Adult Day Health Center (Palo Alto) Golden Castle Adult Day Health Center in Palo Alto is a licensed community -based day health program that provides services to older persons and adults with chronic medical, cognitive, or mental health conditions and/or disabilities in a coordinated program of professional and compassionate services in a community -based group setting. Services are designed to provide social and health services to adults who need supervised care in a safe place outside the home during the day. They also afford caregivers respite from the demanding responsibilities of caregiving. The Program stresses partnership with the participant, the family and/or caregiver, the primary care physician, and the community in working toward maintaining personal independence. Services may be paid for in full by Medi-Cal managed care plans and private long- term care insurance, for qualifying individuals. Individuals may also pay "out-of-pocket" as a cost- effective alternative to in -home care or other long term care services. Conclusions While several CBAS programs exist in the broader Bay Area, there are a limited number within Alameda and Contra Costa Counties. ADP are more prevalent but generally provide services for adults (18+) with developmental/intellectual disabilities, behavioral challenges, and other neurodevelopmental disabilities, and not solely for seniors. Establishing an Adult Day Program (ADP) or Community Based Adult Services (CBAS) is a complex and multifaceted process that can take up to two years to complete. Such programs are subject to stringent licensing and certification regulations which require numerous specialized and technical staff. Furthermore, from Staff's research, organizations that provide these services are private companies, most for -profit; none were managed, maintained, or operated by a City. While ARPA funding would generally be acceptable for seed funding for the creation of an ADP or CBAS, such funds would need to be encumbered by December 31, 2024, and fully liquidated by December 31, 2026, in accordance with ARPA guidelines. Additionally, the City Council approved the budget for the remaining $2.5M ARPA funds through Fiscal Year 2023-24. However, opportunities for a City to support these programs could include either financial support to organizations that provide these services or subsidies to low-income seniors to cover individual costs. If directed, Staff can reach out to these companies to understand what interest there may be in establishing and operating a program in the Tri-Valley and specifically Dublin. Further, if there is interest, Staff can discuss with them the possible space and facility requirements necessary to offer such a program. With that information, Staff could evaluate options in the community or with future development projects. Page 4 of 5 110 STRATEGIC PLAN INITIATIVE: None. NOTICING REQUIREMENTS/PUBLIC OUTREACH: The City Council Agenda was posted. ATTACHMENTS: None. Page 5 of 5 111 I/ DUBLIN CALIFORNIA Item 8.2 Review of Adult Day Services Programs February 7, 2023 El Background • Adult Day Services provided in two types of licensed settings: — Adult Day Programs (ADP) • Non -medical model of care for adults • Trained aides provide structured activities, meals, monitoring services, and protective supervision — Community -Based Adult Services (CBAS) • CBAS programs offer Adult Day Health Care programs in a medical model to Vledi-Cal beneficiaries • Licensed professionals provide organized day programs focusing on health, therapeutic, and social services DUBLIN State Regulation Considerations • Adult Day Programs (ADP) — Licensed by the Department of Social Services Community Care Licensing Division. — Three -Component application process: • Orientation • Application submission • Category Specific Training — Monitoring and annual inspections by licensing agency. State Regulation Considerations • Community -Based Adult Services (CBAS) Licensed by the CA Department of Public Health and CA Department of Agency Required Medi-Ca1 certification Initial financial review Onsite medical and management reviews Facility and staffing requirements Annual inspections and monitoring DUBLIN Local Program Examples 41 Bay Area Community Services (BACS) Choice in Aging Silicon Valley Adult Day Health Care Center Grace Adult Day Health Care Center Golden Castle Adult Day Health Center Oakland, Alameda County Pleasant Hill, Brentwood Milpitas Santa Clara Palo Alto Programs Offered Adult Day Care for seniors with Alzheimer's/Dementia ADPs, CBAS, Intergenerational programming ADPs, CBAS ADPs, CBAS CBAS El s s DUBLIN Conclusions & Opportunities • Limited number of programs in Alameda and Contra Costa Counties. • Establishing these programs are complex, with stringent licensing and certification regulations. • No examples of city operated, maintained, or funded programs. • ARPA funding generally acceptable Must be encumbered by December 31, 2024 Must be fully expended by December 31, 2026 El A DUBLIN Conclusions & Opportunities • Opportunities: Financial support for services or subsidies to low- income seniors. Identify interested companies operating these programs and discuss possible facility support within the community or with future development projects. I/ DUBLIN CALIFORNIA Questions? 3 3 CO