More hospice providers are diversifying their business lines to include adult day services. Some hospices see these programs as an extension of their mission to support aging and chronically ill patients and their caregivers.
Adult day service centers are designed to care for individuals who require assistance during the day in the absence of caregivers or family members. Specific services vary, but these centers typically allow access to community-based social, health and specialized care services that include recreational and therapeutic activities, meals, and medical services. They also provide assistance with activities of daily living such as eating, bathing, dressing and walking.
It “makes total sense” for hospice providers to get into the space of adult day programming, according to YoloCares CEO Craig Dresang.
“The idea of hospice and palliative care organizations now offering adult day support seems like a natural and beautiful evolution and extension of our care,” Dresang told Hospice News. “The more we can support seniors as they age, the better chance they have of living better. This is really bigger than hospice. It’s about aligning a person’s goals of care, their values and their interests with the kind of care and support they receive.”
Adult day is a rapidly growing industry. Centers have become more prevalent in recent years. Currently, more than 7,500 adult day service centers provide care across the United States, according to National Adult Day Services Association (NADSA) research.
This is up from 2018’s estimated total of 4,200 centers which provided care to roughly 251,000 patients nationwide, the U.S. Centers for Disease Control and Prevention (CDC) reported.
Davis, Calif.-based YoloCares, formerly Yolo Hospice, recently completed a rebranding to reflect its growing scope of services while also launching a new adult day program. The program is housed in a new adult day center, Galileo Place, following a $1.6 million renovation on Yolo’s existing campus.
The company last year affiliated with the California Hospice Network, a collaborative of nonprofit hospices seeking to leverage their collective scale and resources in value-based payment programs and expand access to care.
Galileo Place is anticipated to open later this month, said Dresang. Prior to and during the pandemic, YoloCares offered its adult day services on weekends out of a senior center based in Davis, Calif. The completion of Galileo Place will allow these services to expand on a daily basis, according to Dresang.
The pandemic slowed the center’s opening. The need to socially distance was among the challenges faced, as was the industry-wide staff shortage.
While the clinical disciplines represented at adult day centers can vary among organizations, An estimated 80% of adult day centers have nurses on staff. Nearly half have at least one social worker and roughly 60% offer case management services, according to another NADSA report.
Adult day centers also provide family members with reprieve from caring for loved ones. YoloCares will offer a caregiver lab through its adult day center. The lab will feature regular classes for community members to learn caregiving skills such as feeding and wound care best practices, along with self-care.
YoloCares is not alone among hospices integrating adult day services.
Wisconsin-based Agrace last summer also opened a new adult day center. The community-based hospice and palliative care provider serves a total 11,000 square miles of smaller communities, mid-sized towns and the City of Madison.
As with Galileo Place, the pandemic delayed the center’s opening. Encouraging clients to remain masked was among the “biggest challenges” faced during the center’s initial eight months since opening, Agrace CEO Lynne Sexten told Hospice News.
Mask mandates within the provider’s community service region were in place through March of this year. The community-based hospice and palliative care provider serves a total 11,000 square miles of smaller communities, mid-sized towns and the City of Madison. As COVID-19 cases declined in the area, Agrace ultimately saw the benefits of opening the facility outweigh the risks to the community.
Providers launching these programs must “do their homework” to understand the full scope of community needs, along with regulatory and licensing requirements within their state, according to Sexten.
Part of that homework requires providers to forge ties with other community organizations that work or communicate with seniors, according to the NADSA research.
When developing its program, YoloCares established an advisory group that consisted of various community and health groups. With the group’s input, the hospice provider defined their scope of services and identified best practices.
“During this process, we have been in close communication with other adult day programs in our area in northern California, probably half a dozen of them,” said Dresang. “We’ve heard their stories about how their businesses were impacted [by COVID], and it’s been pretty brutal for them. We have some things built in that help us weather those storms with less sweat over our brow, but not everybody is able to benefit from that. The need is much bigger than the capacity available in our communities.”
Developing community ties has allowed for advisory group members to be “ambassadors” for the program. Their advocacy helped build the participant waiting list that Dresang said he anticipates for Galileo Place.
When hospices launch business lines like these, those services do not operate in a vacuum. Programs such as adult day can complement other services that a hospice offers, Dresang told Hospice News.
“All these programs complement one another,” Dresang said. “Humans don’t live in compartments, so our care shouldn’t be presented to the public as being compartmentalized either. The values and needs of people are diverse, and oftentimes connected to other parts of their human existence.”
Coordination of these services may also have other, potentially unexpected benefits.
For example, an adult day program may bring opportunities for hospices to reach patients sooner in their illness trajectories as well as engage with underserved patient populations.
Adult day participants in 2018 were younger and more racially and ethnically diverse, according to the CDC. Nearly 40% were younger than 65, while roughly 55% were Hispanic, African American or other people of color.
African Americans, Asians and Hispanics face disparities in access to hospice care. In 2018 those communities combined represented less than 20% of Medicare hospice patients, the National Hospice and Palliative Care Organization reported. The remaining 80% identified as Caucasian.
Adult day support can also ease family caregiver burden and reduce burn out.
Caregiver burnout has been on the rise during the pandemic, according to Sexten, adding that adult day programs can be particularly beneficial for family members of patients with chronic cognitive illnesses.
“For patients experiencing cognitive decline, the caregiving burden placed on family members is significant,” Sexten told Hospice News in an email. “Too often, families hope to get some relief by enrolling their loved ones in hospice, only to be told the patient is not yet eligible. It is part of our mission to provide relief for those caregivers, while at the same time offering an array of rich daily activities for those with cognitive decline who may someday need our hospice services.”
