Adult day-care centers becoming alternative to nursing homes. The service, like other domestic social programs, is expensive

One of the fastest growing programs to aid older Americans is adult day care. Today there are at least 1,200 adult day-care centers in the United States, while in 1970 only about a dozen existed, according to the National Council on the Aging. The centers are fast becoming a desired alternative to nursing homes, when the care an older person requires exceeds what a spouse or child can provide. Centers now serve 28,000 people, according to results of a recent survey by the council.

``This is a way that keeps [older people] in the community, provides families with some relief, and lessens the costs,'' says Betty Ransom, coordinator of the council's National Institute on Adult Day Care.

``The centers also keep the person involved with others socially,'' she adds.

The goal of the centers, which help those elderly who are physically or mentally impaired, is to assist them either to live independently again or to contribute fully in their current living situations. Many of the centers are in California, Florida, Massachusetts, and Minnesota.

Typically an older person enrolls in the center for five to seven hours a day, three to five days a week. On a typical day an enrollee is picked up at home by a van or small bus and taken to the center, where the day begins with a morning snack and socializing. Group activities go on all day, usually in small groups: music, exercise, arts and crafts, and lunch. Individual help is provided to those who require it.

Like many other social programs, such as soup kitchens and shelters for the homeless, adult day-care centers rely heavily on the generosity of volunteers. The council's survey found that volunteers contributed a total of 81,313 hours a month in the 671 centers that responded to a question about volunteerism.

Even so, adult day care, like many other domestic social programs, is expensive to operate. More than 600 centers responded to the council's budget question. Together, their annual budgets come to $88 million. Medicaid, a joint federal and state program that provides health-related assistance to the poor, pays approximately $17 million of this total. The elderly themselves, or their grown children, pay $15 million. A number of other sources combine to pay the balance.

As with some other expenses, such as private-college tuition, middle-income Americans can be caught in the middle: They are too affluent to qualify for medicaid, yet often too ``poor'' to afford adult day care. Rep. Leon Panetta (D) of California has a proposal that would make adult day care available for many of these families.

Representative Panetta's plan, which will be introduced in Congress, would amend medicare, the federal program to reimburse the elderly for specific medical costs.

Panetta would have participants in adult day care pay $5 a day toward its cost, with the federal government picking up the balance through the medicare program. He would limit enrollment in adult day care to 100 days a year.

The Panetta approach, says Ms. Ransom, would be geared toward those day-care programs that are medically oriented: She says it ``would be advantageous for these specialized programs.''

Whether the Panetta approach can become law in the next two years is questionable. A Democratic-controlled Congress might be willing to approve it, perhaps as part of the effort that liberals will make this year to broaden medicare to cover those areas of medical assistance not now included.

But conservatives in Congress and the Reagan administration are very skeptical about making any change in medicare, for fear that any one change will beget a torrent of others. They point out that by present projections, under the current medicare coverage, the trust fund that finances the program is expected to run out of money in 1995 or 1996. How then, they ask, can medicare be expanded without bringing financial ruin quickly?

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