In 1995 when the publishers of this blog began our foray into adult day care we were aware that public funds could be used to pay for services. The Medicaid waiver was actually new to Wayne County, Michigan and providers of the various services purchased under the waiver were needed to impact the community the way the waiver was intended. Even with this circumstance we did not sit around waiting for contract dollars to kick in.
Knowing what the requirements were for a person to be enrolled into the waiver program in terms of medical and financial eligibility, we launched our own campaign into the neighborhoods where likely waiver candidates lived. We used local religious radio, direct mail and even walked door-to-door. We sent a newsletter and postcard to over 100 nearby places of worship asking them to place information on bulletin boards. Additionally we ensured that local outlets of the State’s Department of Social Services had information posted in their offices.
Before long we were hearing from lower income families who were battling to care for a relative with dementia or who knew a neighbor or fellow worshiper burdened with day in and day out caregiving. We enrolled most of them for a small contribution, generally $30.00 per day and families used this person’s income to pay this contribution to the program. We then referred them to the waiver agent for assessment and Medicaid enrollment. Once the enrollment was official their continued adult day care participation was purchased by the waiver agent and before long we were serving 80 people per day. Since we were the only clinical model program around, needless to say, our growth was crazy.
Since we had two, (2) showers we rendered personal care to those who were obese or survivors of a stroke or catastrophic auto collisions even though they were not enrolled in our program. For this we charged $65.00 per visit and we became a personal care plaza. It was great rendering safe, dignified personal care to those who could not receive it by family at home.
Today, a number of providers enter the business – and we do need them – but they end up quickly under capitalized as a result of the back and forth they may be experiencing trying to line-up direct purchase of service contracts with Medicaid fiduciaries in order to create an income stream. They ignore income potential from outpatient rehabilitation from other sources and other income opportunities.
Problem with this approach is that it creates an early mental dependence on what you cannot control. The result will be frustration and often financial ruin. Additionally you could end up never testing your own outreach and marketing muscle and will not work on honing these skills. We have seen the same thing with some adult foster care providers, especially in Michigan. Many went into business one month and a month later were under contract to receive residents with a community mental health agency. So they really never marketed their residential care services.
When those mental health dollars came under serious cutback many of these providers financially imploded. Why? They had never thought of diversifying their programs to serve other populations and had never honed their skills at marketing and community outreach. For many anger set in, finger-pointing, blaming their professional association and more than a couple ended up in bankruptcy.
Back to your adult day care: Think about the number of people who would love to avoid placing someone they love in skilled nursing or assisted living and who would make usage of your program if only they knew who you were. Think of the number of them who due to wealth may never qualify for Medicaid enrollment anyway but would gladly pay for comprehensive adult day services. But if your sole income focus is on contract dollars through programs such as waivers, you might ignore this other lucrative market while your competitors court it straight to their success.
We are not saying you should ignore contract or public dollars. You should pursue these and add to the list a contract to serve disabled veterans in medical model programs via your local office of the U.S. Department of Veterans Affairs. You should also be reaching out to serve group home residents either being paid by the agency that pays for their residential care or billing the group home directly.
Just be sure you are being both strategic and diverse. After all, the principle of “all eggs in one basket” rarely works as an effective strategy for anything.
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