31 December 2009

Poor Economy, Budget Cuts Hurt Adult Day Care

Crain's Detroit Business

In October 2007, Jackie Smiertka took a big chance when she opened the Quality of Life Center, an adult day health care center in Auburn Hills.

A registered nurse for 30 years, working in hospital pediatrics and in a surgeon's office, Smiertka had never owned a business.

“I worked for a surgeon who performed bariatric surgery, and I followed patients for 12 years out of surgery,” Smiertka said. “My dream was to have my own office and help these patients recover.”

From a business standpoint, however, Smiertka said she struggles to make ends meet, especially with the poor economy.

The 4,000-square-foot center, which has a capacity of 20, charges seniors $50 per day. It uses two full-time employees and several part-time workers to care for the six to 10 mostly impaired older adults.

“These are older folks who should not be left alone,” Smiertka said. “I don't charge a lot because I want to make it accessible to patients.”

Located in the Oakland Technology Park at 3100 Cross Creek Parkway, Quality of Life offers adult day care, respite services for caregivers, medical care for overweight and obese patients and office space to physicians and health care professionals.

It is one of a few centers in that combines Michigan assisted living adult day care with health services, Smiertka said.

Because of the poor economy and reduced subsidies for the centers, Kerri Gentry, manager of Sheltering Arms Adult Day Center in Auburn Hills and Southfield, said most of the 27 adult day centers in Southeast Michigan have fewer seniors than they normally do.

Gentry said the Sheltering Arms centers are operating at about 65 percent of capacity, with Auburn Hills averaging about 10 seniors each day and Southfield about 17.

“Everybody is slightly down right now,” said Gentry, who also is vice president of planning and older adult services with Catholic Social Services of Oakland County, which sponsors Sheltering Arms.

“We break even and have tried to cut costs, but with the state budget crisis, we are caught in a perfect storm,” Gentry said. The centers operate on a $500,000 annual budget, she said.

Gentry said most of the adult day centers have had federal funding cut 15 percent this year from the Older Americans Act. To pick up some slack, United Way for Southeastern Michigan funding helps subsidize its operations, she said.

“We made some staffing adjustments. When staff retired, we didn't replace them,” said Gentry of the center's 21 employees. “Everybody is taking on more responsibility.”

Gentry said Sheltering Arms recently signed a contract with the Veterans Administration, which reimburses day centers for veterans' care.

In addition, the increasing numbers of seniors with long-term care insurance also have helped pay for the $80 average per day charges, Gentry said. Sheltering Arms charges $8 per hour for under 35 hours and $12 per hour for more than 35 hours per week.

As another health care service, Quality of Life also treats bariatric patients who are recovering from surgery, Smiertka said.

Most of the bariatric patients who use the center for post-discharge care are treated by Dr. Mustafa Hares, a general surgeon, who performs bariatric surgery at St. John Macomb-Oakland Hospital, Oakland Center in Madison Heights.

Daniela Scholl, St. John's director of corporate media relations, said St. John doesn't have a direct affiliation with the Quality of Life. She said Hares, who is on hospital's medical staff, refers patients there.

Scholl said St. John's Weight Loss Center is maintaining a busy schedule and has grown 34 percent annually since 2004, despite the poor economy. It was recently designated a center of excellence by the American Society for Metabolic and Bariatric Surgery, she said.

Smiertka said Hares performs about four to five duodenal switch surgeries each month at St. John and refers those patients to the center for post-discharge care.

“Patients come back for the support group and to run in the senior day care room,” she said.

Over the past several years, more than 500 patients have attended bariatric support group classes, Smiertka said.

“After surgery, support group is mandatory and goes on biweekly for the first two years,” she said. “Many continue indefinitely.”

Smiertka also rents office space to several doctors and other providers, who see patients at Quality of Life. The providers include a surgeon, internist, nutritionist and psychologist. She also offers patient education and massage therapy.

“It is very convenient for our seniors to see their doctors here at the center,” she said. “It saves them time, and their caregivers like it because they don't have to make another trip to the doctor's office.”

The practitioners include Dr. Ban Mechael, an internist, and Dr. Wendy Smith, a psychologist. Other providers include nutritionist Patrizia Jesue and therapeutic massager Karen Dermidoff.

Smiertka said the center has recruited two podiatrists and is looking for a dermatologist who specializes in elder care.

“The most difficult part of this job is marketing,” she said. “I don't feel like I should be begging people to come here. We offer great value, and our care is cost-effective and caring.”

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