I've been taking my grandpa to adult daycare for several months now. His medicaid pays for up to 5 weekdays for his adult daycare and I was told by his daycare when he was first registered that they only charge his insurance for days he actually attends and I don't have to call if grandpa is absent from daycare. Well today, the owner of the daycare complained that I should take him more often because if I only take him once a week, "they" (i'm guessing medicaid) do not pay her (the owner). From my understanding, the owner gets paid more by medicaid if he attends more than once a week. She was trying to stress that I should at least take him 3 times a week. It seems when she suggested this, it was more for her benefit (money wise) than grandpa's benefit. I told her the reason why I do not take him as often is because our schedule changes all the time. Also, since I am a full time caregiver of grandpa, he doesn't have to go to daycare 3-5 days a week. Since grandpa is antisocial anyway and he's 91 years old, it takes awhile to be motivated and get ready, he likes the comfort of his own house where he can roam around freely, read, watch tv, sit in his patio relaxing, and eat home cooked meals. I only take him to daycare whenever I want respite and/or so he can be around other people besides me but I feel pressured to take him to daycare every week. One time I took him at the end of the week and the son of the owner acted as if he resented me as if I did something wrong. Sometimes I don't even feel like taking him there because it's not worth the drive if I feel up to par and I can watch him myself. I'm grateful that there is an adult daycare who did accept his insurance because other adult daycares I've contacted only accepts private pay. How do I deal with this situation?
Did his doctor recommend the program? Or how did you find it and why did you start using it? If his doctor recommended the program you could potentially find yourself in hot water for not taking him. Adult Protective Services could be called and a request for investigation of you for isolating him or any number of things.
I think you should take him starting with three days a week, during that time, get together with friends, go out for coffee, go to a movie, do something for you and you alone. It is an exhausting job to have 24/7 responsibility for someone/anyone, especially those with dementia and we need to take the help where we find it.
But do you also "drop by" randomly on the days you do leave Grandpa there just to be sure the residents are being treated properly? If it's not allowed, ask yourself why. Sometimes, it's because the patient sees you and immediately wants to go home and gets upset if they can't go with you. (And many Alz patients do just that.) Sometimes, it's because you might catch the employees goofing off or neglecting the patients. So, have you thought about taking snacks by shortly after lunch, or around brunch, or any other time of the day as an excuse to check on him? (Do this on a day you really didn't want to take Grandpa, so if he does get upset, you can take Grandpa home.)
I always get nervous for the elderly when "money" seems to be the issue, especially Medicaid money, because it usually means the facility is not making enough money to stay afloat, which means cutbacks on services and can also mean they hire cheaper employees which are not always the best for the patients (some of the cheapo employees are drug addicts who will actually steal the elderly's pain medications and other meds. I know this for a fact).
But then, on the facilities behalf, they're probably doing the best they can if they have a lot of Medicaid patients, Medicaid has a weird system of how they pay that makes no sense to anyone, even Medicaid workers can't explain it fully because they don't understand it fully. For example, using a bill of my Grandma's, she received an EOB for an office visit to her regular physician who had charged $100, and Medicaid "allowed" $69 of it as legitimate expense for the treatment/time spent, then they paid the physician $11 and the rest the doctor's office had to write off. So the physician got $11 to treat Grandma for 20 minutes, THAT'S ABSURB! The EOB for the medical tests the doctor performed came to $1,267, Medicaid allowed just under $675 as allowable expenses and paid the laboratory $111 (not even 10% of the original bill) and the lab had to write off the rest. (These ridiculous amounts that Medicaid pays is standard, so I'm not using a low ball example, I literally have hundreds of such bills for Grandma.) So, the DayCare, if they have a lot of Medicaid patients, really does need to have the establishment full most days just to get any money at all. And they usually have to skimp on services rendered because they can't afford to provide much and not go broke. It's a vicious cycle and the reason so many Elderly DayCare facilities are private pay. They have to at least break even and most of these are the owners/workers only job, so it has to be profitable so the families of the owners and workers don't starve to death.
Perhaps you could take snacks to the employees once a week to show them how much you appreciate them. That goes a long way in assuring your Grandpa gets treated properly. A little kindness goes a long way.
Just don't forget to drop in randomly to keep them honest!
Good luck to you and God Bless YOU for taking such great care of your Grandpa!
I agree, these places are normally licensed for a maximum number of participants each day. And if Grandpa doesn't show up that is a space that could be used by another. Good point! The daycare needs to fill their permitted slots on a daily basis especially if it is Medicaid funds that pay for it. I don't know what the rate is but it is quite low.
The program my husband attended was absolutely excellent. I cannot say enough good things about it. I would recommend it (and have) to others in this area. But it was not set up to be a drop-in care center, and that would not have been allowed.
What I see in this post is perhaps a misunderstanding of the nature of Adult Day Health Centers. They expect scheduled attendance, on consistent days. If you need a drop-in center on random days, that is what you should be looking for.
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