Lawmaker seeks $5 million to expand adult day centers

South Dakota had 30 state-registered adult day centers scattered across the state at one point. The services provided low cost programming, care and supervision during the day for people who were elderly or disabled, and let them return to their homes and families at night.

Now, there are only three left: one in Rapid City, one in Aberdeen and one in Sioux Falls. There are other centers that offer adult day services, but they aren’t contracted with the state and don’t receive Medicaid reimbursement.

The centers are regularly full and can’t fill the demand for their services, as adults increasingly choose to age at home instead of moving into a nursing home. 

Rep. Taylor Rehfeldt, R-Sioux Falls, believes the decline in adult day services is due to poor Medicaid reimbursement rates by the state and expensive start-up costs for providers to enter the field.

So Rehfeldt introduced House Bill 1078, which, if passed, would allocate $5 million in grants for health care providers to expand or establish new adult day services across the state. The bill is scheduled for its first hearing in the House Health and Human Services Committee on Tuesday.

Rehlfeldt said the closure of 28 nursing homes in South Dakota during the past eight years has created a greater need for adult day centers.

“If we keep having nursing home closures, these people aren’t going to have anywhere to go,” Rehfeldt said. “We have to have some way to care for them, and this is a component of that.”

Rehfeldt’s grandfather died of Alzheimer’s disease, so she saw the importance of adult day services to keep him engaged during the day and let his loved ones work or have free time without constantly supervising him.

Richard Butz’s wife regularly uses services through Active Generations. She’s currently attending the Ceili Cottage, which is one of two adult day services under the Active Generations umbrella. 

His wife was diagnosed with Alzheimer’s at 56. Four years later, Butz still works regularly since he hasn’t reached retirement age and needs to provide for them.

People with disabilities or Alzheimer’s are more prone to depression, Butz said, and such services help to enrich those people’s lives. People using adult day services at Active Generations include those suffering from Alzheimer’s, ALS, strokes and more.

At the end of the day, Butz is able to connect with his wife as she shares how her day was — acting as a husband instead of a constant caregiver.

“I think about those people who don’t have this tool in their pocket like I have, and I feel badly for them,” Butz said.

It’s “terrible” to have so few services in the state, Butz added.

$5 million in grants from the state’s general fund would ensure there’s “enough money to fill the need,” according to Rehfeldt.

According to the most recent data from the state Department of Health, there were 174 consumers receiving adult day services, said Thomas Elness, director of public policy with the Alzheimer’s Association of South Dakota.

But the demand is greater than that.

The Alzheimer’s Association estimates there will be 20,000 South Dakotans diagnosed with Alzheimer’s by 2025, up from 18,000 in 2020. 

“There’s a lack of support for caregivers,” Elness said. “We know that caregivers are skipping out on their own doctor and dentist appointments and grocery shopping errands. Their mental health takes a hit from having to be a caregiver constantly.”

Rehfeldt is in discussions with the state to reevaluate the Medicaid reimbursement rate for adult day services. As of July 2022, adult day services were reimbursed at $1.60 per 15 minutes for patients — about $6.40 an hour or just over $50 for an eight-hour day.

While Rehfeldt’s legislation would fill a need to address start-up and expansion costs, reimbursement rates affect the sustainability of businesses, Elness said.

“You can see very quickly how that business model doesn’t work,” Elness said.

Adult day services costs are about one-fourth as expensive as nursing homes, Elness added.

“From the state’s perspective, there’s immense cost savings to let more people be served by adult day services,” Elness said. “Even in-home care, which we support, is expensive. Adult day care is one of the greatest, most cost-effective services the state could utilize.”