Adult Day Services Ease Isolation, But Aren't Always Viable

(This article was provided by The Op-Ed Project, which aims to increase the range of voices we hear in the world.)

Millions of older adults in this country fear they will become victims of crimes. As a result, their isolation negatively affects their mobility, as well as their emotional and physical well-being. One solution can be adult day care services, but new complications of their costs and policies threaten service access nationally.

Only 7 percent of all U.S. crime victims are older than 66, according to a new FBI report. (Of the more than 4 million crime victims in 2015, the largest group, at roughly 24 percent of the total, were between 21 and 30.) Still, older adults fear they will be the unintended targets of crime. In response to the perception of neighborhood dangers, many lock themselves inside their homes and only go out during daytime hours for necessities like doctor visits or groceries.

An existing, but underutilized, resource that can combat this social isolation: adult day services. They provide transportation to a community-based center offering comprehensive health and social services. Adult day services also offer greater socialization than can be given in-home or in a community center. Yet, access is limited by cost and availability.

Older adults attend day services by paying out-of-pocket or through Medicaid benefits. The $61 average cost per day is prohibitive for many, which partly explains why only 282,200 of the 46.2 million older adults in the U.S. access them.

There are also too few facilities. In 2014, there were only 5,685 day programs nationwide. In comparison, 15,600 nursing homes provide care to 1.4 million older adults.

As a physical therapist and public health researcher, I investigate physical activity among older adults, specifically in Chicago neighborhoods with high crime rates. Recently, a male patient remarked, “It’s dangerous to us seniors to be out there a lot of times.”

But prolonged isolation has health risks equivalent to smoking 15 cigarettes a day. It also disturbs sleep and contributes to depression and fatigue.

In these neighborhoods, leisure activities such as enjoying an outdoor walk or sitting outside are not possible due to the threat of crime — or the perceived threat . Here, my older patients are essentially prisoners in their own homes.

Isolation further deteriorates physical health by contributing to de-conditioning and weakness. One elderly female maintained her safety by never venturing off her block and lamented that “fear sort of cuts walking down now.”

Reduced community walking is particularly concerning because lower amounts of outdoor time can lead to greater depression and indirectly contribute to muscle weakness and poor cardiovascular functioning.  As older adults are restricted to their homes, they have increased physical deterioration, ultimately making them need a caregiver or be placed in a nursing home, a much more costly alternative.

Of course, the long-term solution to reduce fear and isolation among older adults is to decrease crime and improve neighborhood safety. However, stopping violence is not a simple endeavor and efforts require ongoing individual, community and police efforts.

In the short-term, older adults need social services that offer a respite from isolation in their high-crime neighborhoods.

To address this gap of need and accessibility, we need to first increase awareness of adult day services among older adults and their families. Clinicians and health care systems can recognize adult day services as a viable provider of post-hospitalization care.

For older adults without Medicaid, expanding Medicare to provide reimbursable community-based long-term care services would increase accessibility to older adults. Making adult day services reimbursable may also provide an incentive for the development of new centers or expansion of existing facilities to meet the needs of a rapidly aging society.

Medicare Part B already covers a number of preventative health services, such as obesity counseling and nutrition therapy. It is time to view adult day services as preventative services that can avert costly hospitalizations or delay institutionalization.

As the new Trump administration considers alternatives to The Affordable Care Act (ACA_, repealing the ACA without a replacement plan may leave Medicaid beneficiaries without access to needed long-term care services, further isolating older adults.

The ACA incentivized states to shift long-term care spending from nursing home to community-based services. Other provisions included expanding community-based service options, increasing service offerings and facilitating the transition of nursing home residents back to their communities.

President Trump has advocated that we need to “reduce our dependence on public health programs.” But scaling back important social services will endanger the lives of vulnerable older adults.

We cannot let older members of our society continue to be isolated because of unsafe communities and a fear of becoming victims. We need to continue health policies that provide affordable and accessible community respites for older adults to receive social interaction and care.