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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?

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@msdiva - that's good to know. Been studying and learning more about the law of attraction. It seems like businesses who care more about humanity than money itself attracts more business and stays in business longer.
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That's what I thought it was about money she figured if he comes more days she can get more money...here in Ks it doesn't matter I taken care of people that goes only once a week and it never issue so the --- with her
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Oldfriend2me's answer was really helpful as far as advice from the provider, which you must remember is a business and in it to make money. Whatever the medicaid provider rules, you also have to ensure that the business is willing to work with you. That said, as others have mentioned the place you go to should have clearly communicated their needs/issues to you. It sounds as if they are not good at that so perhaps it would be helpful if you started that conversation by telling them what your needs are and why and asking them what theirs are as a facility, and trying to find some common meeting ground between the two.
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It might be fine with medicaid, but the facility will likely fill your spot with someone else who comes three days a week.
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That is good news, 75104, but maybe the daycare is not able to hold a space for him without regular attendance. They can only have a specific number each day.
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I called my grandpa's medicaid to know what the guidelines are for his adult daycare program. Medicaid confirmed that the daycare only bills them when my grandpa attends. I asked medicaid if they knew why the daycare owner said that they don't pay her if grandpa goes only once a week. Medicaid said that they DO pay her but it's not much and she "prefers" that he goes a full week for more pay. I told medicaid my grandpa can't do a full week because of his age and his limitations so we go on random days/hours and medicaid said it's fine.
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Reverseroles, I am sorry that you apparently have had bad experiences with adult day programs. We went to one that was less than stellar, too. But the nonprofit we used for several years definitely cared about their clients as people.
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Hi Reverseroles, Medicaid won't pay unless the person actually attends. So if they're expecting him and he doesn't come, they don't get reimbursed. Medicaid considers it fraud to bill for no-shows.

Daycare has to staff for the number of people expected and they have to pay their staff regardless. It certainly could have been handled better by the daycare- just communicate with the client. It's a much better strategy than chewing out the client.
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My Moms previous daycare said they have to come at least twice a week. I guess you could say bill medicaid anyway and you will bring him when you want , or get a new daycare. routine is important for your Dad at 91, how does he feel about it? If you only want here and there, why not hire an on call person to come to your house. Daycare is a business and money is the root of it all, believe me. When you stop going, you will understand that they didnt care about them as people at all, its great for you but money in their pockets for them. Daycares can be quite different, make sure you have a good one!
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Jessie-
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.
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No matter how many days he goes or how much $ the program is loosing, NO ONE should be speaking to you like that! Stand your ground. If they speak to you like that, then I would worry how they speak to the Elderly who they are suppose to be caring for daily!

You have enough on your plate, don't be taking crap from them!
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msdiva, a good day program sets up activities for their participants, orders or makes meals for them, has entertainers or other programs on certain days, has some continuing activities for people who come on certain days (for example, reading a chapter in a novel every Monday), and is staffed to care for a certain number of participants. If they are staffed and order lunch for 30 people on Mondays, 32 people on Tuesdays, and 29 people on Wednesday, Thursday, and Friday, it is very disruptive to have people switch days without advance notice or to reserve a spot every Wednesday but to only show up once in a while. These places are not set up as drop-in babysitters. They work out a care plan for each individual, and they cannot carry it out when the individual is not there.

I really sympathize with what caregiver75104 would like. I, too, would have liked a place where I could drop my husband off only on days I wanted to. I did not find such a place. A reputable, quality Adult Day Health Program, cannot operate effectively on that basis. My husband's program was definitely NOT "all about the money" -- they were nonprofit -- but without money they couldn't run a quality program in the best interests of their clients. They need to know who to expect on which days in order to set activities up appropriately, to ensure that staffing matches the enrollment, and to be able to count on reliable income. Obviously they have to factor in sick days, days their clients are out of town, etc. But they cannot function at their best with random attendance.

It is unfortunate that the place caregiver75104 takes her grandfather has not communicated clearly their expectations.
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Im not getting this I guess different state have difference guidelines ..but I know if your taking him once a week I know they don't get a weekly check for him so what the fuss about rather he's there one day or 5 days ..there getting paid and far as space they should have taking care of all this when he first signed up for this.. sounds like this is all about the money
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Is this facility set up as a drop-in respite provider? The one my husband attended was not. He could go one day a week or 5 days a week, but it needed to be arranged in advance and be consistent. Occasionally I would call them and say "Coy cannot come in as usual on Monday, but would it be OK for him to come on Wednesday instead?"

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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Yes, it sounds like it's about the money. When my mom first started attending adult daycare, it was recommended that she attend at least 2 to 3 days. Initially we were paying out of pocket with some grant assistance. As her dementia progressed and after having a stroke in 2009, she attends 5 days a week. Medicaid approved 5 days a week. Her neurologist also recommends 5 days a week as tolerated. In general, most recommend at least 2 days a week for the seniors to get into a routine and accustomed to the facility. On most part, the daycare has helped mom. She seems to have more clarity. On the financial side, they are looking to fill as many slots as possible with guaranteed payment. Daycare is a business and unfortunately, some are putting business before quality service.We have to call when she is not attending and give a reason. The daycare has to report the services rendered to your grandpa to the state. This is to prevent fraud. It's unfortunate that there are limited services and/or facilities for those with Medicaid. But you should not feel pressured. You know what's best for your grandpa. If you have someone else you can trust and can rely on to help your grandpa get to the daycare a day or two extra could help. Medicaid also pays for in home aides. The daycare should have explained and/or suggested 2-3 days and the policies/rules. Also, his case manager should have explained what's covered. I pray and hope for the best -whatever you decide to do in the future.
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lulubear, your thoughts are the same as mine. The daycare is probably holding a space that could be used for someone else. It is a huge revenue loss to them if a client only comes in once a week. I have a feeling that what they meant was that they expected him there daily, but there was no need to call on days he wouldn't be there. Probably they didn't have any idea that it would be almost every day.

caregiver, ask them if your dad is occupying a space that could be used by someone else. The daycare may be limited to a certain number of clients. If those clients don't show up, the daycare can't afford to keep the doors open. If that is the way their business is set up, I believe the only good choices would be to take your father more often or to drop out of the service. Talking with them about it will let you know what they are up against and will help make the decision what to do.
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@pstiegman Yes I agree. Daycare does keep the mind active. Daycare does help me alot as well when I need to get chores done and run errands. If only the daycare owner should have told me in the beginning about their policy on attendance, I would have abided by it. I even told the son of the daycare owner in the beginning when grandpa was still new that I may not be able to bring him all the time and his attendance may fluctuate sometimes it may be once a week or more because it depends on both of us and he understood like it was acceptable. Maybe he doesn't communicate with his mom (the daycare owner) LOL.
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Thank you for everyone's support. I asked the son of the daycare owner, who is the director and one of the people who helped registered for grandpa's care, "Do you want me to call if grandpa is not coming?" and they said "No because we will know anyway that he's not here." Then when I got "reprimended" by the daycare owner about coming more often, I asked her also, "Do you want me to call first if grandpa is not coming?" She said "No."
We go different days. there is no set days when grandpa goes to daycare. The son of the daycare owner has never mentioned anything whenever we go different days or different times or once a week because he is busy running the facility. And also, there is no written policy on what the rules are regarding the attendance, they just verbalize it.
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Adult day services do not like respite drop-ins. Why is this you say....as an on call employee of an adult care center, we had to plan our activities and staffing for the number of anticipated clients, and be able to call in people like me if we knew that there would be extras. These centers are not meant to be drop ins. It messes things up. I would be upset if that were the case. And I would really be upset if the family did not contact us re a planned client's absence. We order lunches for the anticipated clients, as well as other stuff. So, all that being said I think socialization is good, friendships are formed, and a little change is good for grandpa. At least take him 2 days a week. And yes places do depend on insurance, private or whatever. There are many people who would be so happy to give their loved ones the opportunity of day care, and themselves a planned respite to shop, get doctors appts., etc. So if you love being the full time caregiver go for it. Maybe consider an adult community center or church instead, for occasional activities, or a caregiver to come to your home when you want a break. But don't bring cookies. If you DO choose day care, come for lunch we would love to have you! And make arrangements for the van if you need it.
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I have a sister in adult daycare and it keeps her mind active. Most of these places have a waiting list, and they need a commitment from the client to keep their funding and keep the place open. If all the clients showed up only occasionally, the place would close up. Three days a week will be good for him, boredom kills.
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I always called when my mother wasn't going to be there on her scheduled days. It's just a courtesy. We were private-pay so we didn't have to follow Medicaid rules but I know Medicaid will not pay for no-shows even though the center has held a space open for your grandfather. They expect no-shows occasionally but it sounds as if your grampa is a chronic no-show and they need the reimbursement to stay in business.
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Well this is how it has been for me, mom was reluctantly released from respite care in December . They said she needed to be placed in a long term residential care. I just said, let her come home I will care for her. I did everything that they suggested and one thing was for her to go to daycare. Well it sure was exhausting, the cleaning of her, the dressing of her, the big breakfast, I did it. The bus would be here anywhere from 10 am to 11:30, you just never knew it was a real anxiety producing event. She'd be ready to go and we had to wait, sometimes at noon they'd call and say the bus broke down. The effort was still made and the anxiety of waiting was terrible. She'd be obsessive compulsive and go to the bathroom a million times, each time I had to rearrange her clothing, she'd stuff rolls of toilet paper in her pants and pockets. By the time they came, I was a wreck and the few hours I had to myself became a time for me to calm myself. The bus was broken down more often than not, they had two week constant vacations and I was told their is no staff. I was told well, she will be back early today, so you could not do anything, I have a bicycle to get around on, the stress of trying to get to a bank or haircut or any appointment left me so stressed out. I had to be here when she came back. They would bring her back and more often than not say she will not be able to come back for two weeks with more reasons. So, I understand the limitations of this. I would say if they can take him, let them. I did it for nine months with great detriment to myself, but it is good for them. Good luck.
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The above answer is spot on! Do see what the guidelines are and be sure this DayCare if following them!

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!
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Playing devil's advocate, I understand that schedules change constantly when taking care of an elder. You have to be available whenever you are needed to do whatever is in their best interest, which I believe the day care is. Outside socialization for him, whether he is antisocial or not, is very important for you and him. In my case I am able to work appointments around day care, so mom is still able to attend most days. How far is the day care from where you are living? It will take a while for grandpa to become accustomed to going and I know it is difficult to get them ready, believe me!! But the outside activity could potentially slow the progression of the disease. You may find that he makes friendships which would be very good for him whether he remembers or not. In my case taking mom each day is a challenge as she does not remember ever being there before. But, each day when I pick her up she tells me she has had a wonderful day. She often says I had a fun day, but I don't remember what I did.

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.
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I think you should start by contacting Medicaid and find out the rules that apply to payment for adult daycare. If the Daycare is licensed by Medicaid there will be strict guidelines they have to abide by
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