Adult Daycare Programs Are Highly Susceptible To Fraud And Abuse

Adult daycare centers provide dependent adults living in the community with care and supervision in a protective setting. Centers can be either medical or social. The medical adult daycares are regulated by the State Department of Health while the social are not. It is in the area of social adult daycares where there has been a large amount of growth in New York.

These centers are meant to keep seniors in a safe daytime environment and make sure they are properly fed and medicated. Some of the other services provided are social and recreational activities and essential training for sustaining activities of daily living. However, legal advocates for the elderly have become concerned about the social adult daycare programs. Given that there is no requirement of a license to open them and there is no government agency responsible with visiting or inspecting them even though they are eligible for government funds. For these reasons, these centers may be susceptible to fraud and abuse.

Recent changes in state regulations have made adult daycare centers potentially very lucrative for their operators. Previously Medicaid only reimbursed adult daycare centers for one specific group of individuals, those who needed help with a daily living activity or have dementia. Since Medicaid was overhauled and turned into a managed care system, private insurance companies will now reimburse adult daycare centers per adult for a larger group of people. The hope behind this practice is that it will keep seniors out of the more expensive types of care, such as nursing homes.

These changes have created a competition for all seniors eligible for Medicaid. Unfortunately, many of the new business owners care more for the bottom line rather than the elderly. This could create a situation of neglect, especially if the senior is someone who needs help and qualified for adult daycare prior to the changes. The Department for the Aging has guidelines for adult daycares that mostly provide social activities for seniors; however it only monitors the centers it contracts with. The others are not supervised by the government because it says that that is the responsibility of private insurance companies. However, it has been said by one private insurance company that it is not their job to regulate adult daycare centers. Without supervision the likelihood of neglect increases.

The system now works so that private insurance companies receive a set reimbursement for every Medicaid recipient they enroll. Previously, in order for an elderly person to be eligible for adult daycare they need to be helped with at a minimum of one daily living activity. Such activities could be toileting or feeding themselves. However, under the current system some adult daycares are recruiting elderly persons who are active and healthy.

There are so few rules that the centers need to abide that it would be difficult to charge them with medical malpractice should any negligence occur. Without review and supervision of the centers there is no guarantee that that any state guidelines will be followed, which may increase the likelihood of medical malpractice.

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