ADHCC Submits Testimony to Health/Medicaid Joint Legislative Public Hearing

Medical model ADHC programs were instructed to temporarily close on March 17, 2020 and have not been permitted to re-open. Since then, ADHC registrants across the state have gone without personal care, therapies, and skilled nursing services – needed services that cannot be adequately provided through telehealth services. This has resulted in a spike in preventable hospitalizations, nursing home admissions, and overall decompensation of registrant health and hygiene. In addition, ADHC programs serve a large population of individuals diagnosed with severe and chronic mental illness, one of the populations most at risk for physical and mental health complications due to prolonged isolation.

ADHC registrants are reporting extreme loneliness and often call their program pleading to return. While the State has suggested that telehealth is a tool to assist during this pandemic, it is not a replacement for human interaction for those who need it most. ADHC registrants require necessary nursing services and therapies, as well as companionship and purpose.

For registrants who have been fortunate to have help from family or caregivers during the last year, those family members and caregivers are returning to work and are unable to find alternative arrangements. In many parts of the state, there are simply not enough home health aides or private duty nurses to care for individuals in their homes. ADHC has been lauded as a solution to the chronic workforce shortage, but ongoing closures, especially in rural areas, have exacerbated the issue. ADHC must reopen to lessen the strain on home health and so that caregivers may return to work. Families deserve to know when their ADHC program will reopen.

A large percentage of ADHC staff have received their first or second dose of vaccine. Unfortunately, due to insufficient and inconsistent supply, ADHC registrants are getting vaccinated at very low rates. Approximately 8,000 New Yorkers attend ADHC programs. If open, ADHC registrants could get vaccinated at the sponsoring nursing home during their ADHC visit. This approach would be much easier for the registrant – they would not have to schedule an appointment in the community, wait in line for hours, and then go back three weeks later. It would also save the State money because Medicaid would not have to pay twice for an aide and transportation to the community vaccination site. If ADHC programs were allowed to reopen, thousands of New Yorkers could get vaccinated as soon as vaccine shipments arrived in nursing homes.

Finally, the Adult Day Health Care Council (ADHCC) wrote and submitted recommendations to DOH in May 2020 on how ADHC programs would prevent the spread of COVID-19 and safely care for ADHC registrants. The proposal to reopen programs was pragmatic and cautious, and it followed Centers for Disease Control and Prevention (CDC) and DOH policies such as infection control and social distancing. Even though the State agreed with the tenets of the proposal, there is still no timeline to reopen ADHC. Furthermore, there has been no communication from DOH to ADHC providers since March 17, 2020. At least 12 programs have permanently closed since the pandemic started. Without a reopening date, the State should expect many more to permanently close. The State will then see even more hospitalizations and nursing home placements as registrants of these programs decompensate.

Recommendation: Reopen medical model ADHC programs. ADHC remains the only health care setting unable to provide in-person services.