White Coat Notes

Rules unveiled to license, inspect Mass. day programs for frail older adults

Thousands of older Massachusetts residents, many with dementia, receive health care and participate in social activities in adult day programs that are not licensed and routinely inspected, but proposed rules unveiled by state regulators Wednesday would change that.

The rules would require the programs to be inspected every other year by the state health department, and mandate minimum staffing levels, infection control measures such as showers and hand-washing stations, and separate spaces to provide activities for those with advanced dementia.

“This is a community-based service, and we believe these regulations can represent a potential quality improvement ... preventing hospitalization and extending the time before it’s necessary to institutionalize folks from the community,” Dr. Madeleine Biondolillo, director of the state Bureau of Health Care Safety and Quality, told the Public Health Council, an appointed body of academics and health advocates.

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The council is scheduled to vote later this fall to finalize the rules, after a public hearing.

Roughly 11,500 residents are enrolled in about 145 adult day health care programs that receive Medicaid funding, according to 2011 state figures, the most recent available. But Biondolillo said officials are unsure of how many other programs may be operating, noting that some estimates put it as high as 50 more.

“This will bring everyone into the same regulation tent,” she said.

Adult day health programs were facing significant cuts in state funding in 2011, which the industry said would force most to close. Instead state lawmakers preserved the funding but passed a law that required programs to become licensed and directed the health department to create rules.

Darcey Adams, president of the board of directors for the Massachusetts Adult Day Services Association, said the industry welcomes the stricter oversight but worries it might drive up costs.

Medicaid reimburses program operators between $58 and $74 daily for each participant, depending on the level of care required, but the association says the true costs easily run about $10 a day more for each patient. Association and state health officials said its not yet clear how much the proposed changes may increase costs.

“It’s a balancing act,” Adams said. “When you look at health care reform, programs like this that are based in communities where people live will be increasingly important because they keep costs down, and it keeps people in the homes where they want to live.”

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