A slot at the Total Life Center adult day care in Garner has been a lifesaver both for Margaret Toman, 65, and for her mother, Lou Longest, who is 97.
"It means my sanity," Toman said. "My mother is an inherently social person who loves people, likes to be around people, interacts beautifully with other people.
"For her to be closed up here 24 hours a day would be bad for the mental health of both of us," Toman said in a telephone interview from her home.
But a proposal in Gov. Bev Perdue's budget would take away about $1.1 million in funding in the State Adult Day Care Fund for anyone older than 59. Instead, the care is supposed to be paid for through Home and Community Care Block Grants - money that counties can use for in-demand services such as Meals on Wheels and in-home care. Across North Carolina, such block grant programs typically have as many as 15,000 people on waiting lists.
"The reason it's cut out is that it was a duplication of services," said Chris Mackey, a Perdue spokeswoman.
However, the governor's proposal means that adult day care will be vying for funding from a source that is already stretched trying to provide for a wide range of needs, social service officials said. The loss of more than a million dollars in the adult day care fund means that less money will be available to reimburse centers for the care of Longest and others like her, said Michael Boles, director of adult day services at Resources for Seniors in Wake County.
Adult day care centers provide protected daytime activities and fellowship to older people who for various reasons can't stay by themselves. The centers also allow caregivers, often adult children, to hold jobs and do myriad other tasks that would be next to impossible while looking after an older person with disabilities.
About 3,500 older people across the state make use of adult day care. Many have caregivers like Toman, who lost her job last year and is looking for work while also looking out for her mother.
"She's so representative of so many people," said Teresa Johnson, executive director of the N.C. Adult Day Services Association. "We're really trying to mobilize family caregivers. They receive the service; they recognize the value of the service."
Most adult day care operations accept private and tax-paid clients, and the mix helps make up for the relatively low state pay rates, said Gail Holden, director of adult services for Wake County Human Resources. Adult day care is a key element to keeping many older people out of long-term care, which is typically much more expensive to the resident, she said.
"Without this care, they'll wind up in a facility or they'll be at home alone," Holden said. "It's very concerning."
'String and gum'
Longest had been living in senior housing in Aberdeen until her dementia worsened.
"She started having hallucinations," Toman said.
So, Toman decided to bring her mother to live in Wake County. After 25 years in a Raleigh apartment, Toman gathered her resources to buy a small house in Garner so her mother could come live with her.
"Since losing my job over a year ago at age 65, I have been holding things together with string and gum, figuratively speaking," Toman said. "My mother and I are the entire nuclear family. Everyone else is gone.
"I will not let her go into a nursing home if I can possibly help it."
However, long-term residential care may be next for many older adults if Perdue's budget passes as written. The GOP leadership has asked for deeper cuts to deal with the state's projected $1.9 billion dollar budget gap.
"This one really worries me," said Holden, the Wake official. "The adult day care centers are just happy places. You can still live at home, you have peer interaction."
Teresa Johnson, who leads the state's trade association for adult day care centers, says there are about 100 such centers in the state. Daily costs range from about $40 to $75.
The need for care
According to a 2010 study by the MetLife Foundation, the number of adult day care centers nationally has increased by 35 percent during an eight-year period.
Increasingly, centers are adopting the adult day health approach, in which clients have access to a limited amount of medical care. Such centers charge a little more than the once more common "social model."
"People are sicker and needing more care," Johnson said.
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