I Have a Moral Problem with Adult Day Services Programs Who Take Pride in Avoiding Serving Medicaid Recipients

I Have a Moral Problem with Adult Day Services Programs Who Take Pride in Avoiding Serving Medicaid Recipients

Adult day care/health programs promote medical stability, cut into self-neglect among the elderly and disabled and keep families together.  For decades America and the world have benefited from these innovative initiatives.

Most who enter adult day care do so with an understanding of the need to cover costs and earn a living, but without the profit driven motives governing the thinking of so many today.  When I started in 1994, we knew the $30.00 per day average Medicaid waivers paid us was not going to create wealth.  For that reason, we situated ourselves in an area where we could draw those who would never qualify for Medicaid enrollment.

This provided a healthy stream of income from private sources that helped to offset what we could not make from others.  Even labor union’ health funds were paying us for services.  It’s not rocket science by any means.

Hospitals, nursing homes and other care providing models have positioned themselves identically for 100+ years.   They know they will earn less from the Medicaid patient, but they accept they too must be served and offset it with medical savings accounts, private health insurers, Medicare, worker’s comp and auto no-fault personal injury funds and more.  The right mix gets you to the desired result.

Where I get concerned among the newer care entrepreneur, (a term that comes with its own set of questions, as most of them are not clinical professionals) is when Medicaid is talked down upon for reasons such as:

a. They don’t pay enough, or

b. They want too much work, referring to agencies who administer Medicaid funds

First of all, I just explained how to position oneself to benefit from the offset by mixing socio-economic populations so as not be an elitist in a world that does not need any more of these.  No one said a program should be established solely to serve those enrolled in Medicaid waivers.

Secondly, too much work?  Its public money.  Would not you expect a bit more documentation to justify receipt of these funds?  Do you not want and appreciate a few guardrails in a country with significant waste of public assets already?  Thirdly, work is work and in the business of care, professional documentation saves lives.  To me, it comes across as blatantly unpolished and immature to complain about added documentation to serve someone who may need your program the most.

Something else worries me, as I look at the level of intimate attention I have personally given to adult day care enrollees.  I worry about the person who enters this business with the same mindset as the real estate developer, laundromat owner, mass transportation entrepreneur, etc.  In these instances, it is often strictly about the money.  

While earning is neither bad nor wrong, it can create a wealth of issues in the business of care when it is the chief priority.  No, this does not mean that the care driven entrepreneur must take a vow of poverty, which would be absurd.  This is a capitalist marketplace, and we all benefit from that.

But I can tell you I have seen years added to lives because in adult day care/health centers I have owned or mentored:

a. Glucose was stabilized due to the efforts of our team.

b. Hypertension was stabilized due to the efforts of our team, and strokes likely avoided.

c. Malnutrition and dehydration were eradicated among seniors and others who were home being neglected or neglecting themselves.

d. Skin care and skin integrity were enhanced due to the efforts of our team.

e. Incontinence was managed with dignity.

f. Depression was better managed with structured, person-centered activity programs under the supervision of a geriatric care professional.

These are benefits of the program with a true commitment to serving the entire person. Hopefully, the world ends up with more of these who will organize themselves to serve a varied population

We would love to hear your thoughts.

Another Blog Post by Direct Care Training & Resource Center, Inc.

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